Premature infants often require breathing support with a ventilator (respirator). Although ventilator support if life saving for these infants, prolonged ventilator use is associated with the development of chronic lung disease. Strategies which help premature infants wean off the ventilator earlier are associated with a reduction in chronic lung disease. A form of breathing support called CPAP (continuous positive airway pressure) is routinely used to help premature infants stay off the ventilator. CPAP provided a small amount of positive pressure to the airway of the infant during both inspiration (breathing in) and expiration (breathing out) through prongs that are placed in the infant's nose. Unlike the ventilator, CPAP does not provide assisted breaths to the infant, but is thought to reduce the work of breathing by helping to keep the airways and lungs expanded. The type of CPAP most frequently used in the United States uses continuous gas flow to provide positive pressure through nasal prongs. The pressure delivered to the airways varies with the position of the nasal prongs and with the inspiratory and expiratory efforts of the infant. In Europe, a new CPAP device, called the Infant Flow system, has been developed which is capable of varying the flow rate with the baby's breathing effort to provide a constant pressure. However, whether the Infant Flow CPAP system is really better than conventional CPAP for the successful extubation of extremely low birth weight infants has not been conclusively demonstrated. This research study is to determine if the Infant Flow CPAP system is superior to conventional CPAP for the successful extubation of extremely low birth weight infants. Approximately 160 infants will be enrolled in this study.
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