Failure of Early Non-invasive Ventilation in Preterm Infants with Respiratory Distress Syndrome in Current Care Practice in Spanish Level-III Neonatal Intensive Care Units - a Prospective Observational Study

Overview

Journal Front Pediatr

Specialty Pediatrics

Date 2023 Mar 10

PMID 36896404

Authors

Hector Boix

Cristina Fernandez

Maria Del Mar Serrano Martin

Luis Arruza

Ana Concheiro

Ana Gimeno

Ana Sanchez

Segundo Rite

Francisco Jimenez

Paula Mendez

Juan Jose Aguera

Affiliations

Soon will be listed here.

Abstract

Introduction: Despite advances in respiratory distress syndrome (RDS) management over the past decade, non-invasive ventilation (NIV) failure is frequent and associated with adverse outcomes. There are insufficient data on the failure of different NIV strategies currently used in clinical practice in preterm infants.

Methods: This was a prospective, multicenter, observational study of very preterm infants [gestational age (GA) <32 weeks] admitted to the neonatal intensive care unit for RDS that required NIV from the first 30 min after birth. The primary outcome was the incidence of NIV failure, defined as the need for mechanical ventilation for <72 h of life. Secondary outcomes were risk factors associated with NIV failure and complication rates.

Results: The study included 173 preterm infants with a median GA of 28 (IQR 27-30) weeks and a median birth weight of 1,100 (IQR 800-1,333) g. The incidence of NIV failure was 15.6%. In the multivariate analysis, lower GA (OR, 0.728; 95% CI, 0.576-0.920) independently increased the risk of NIV failure. Compared to NIV success, NIV failure was associated with higher rates of unfavorable outcomes, including pneumothorax, intraventricular hemorrhage, periventricular leukomalacia, pulmonary hemorrhage, and a combined outcome of moderate-to-severe bronchopulmonary dysplasia or death.

Conclusion: NIV failure occurred in 15.6% of the preterm neonates and was associated with adverse outcomes. The use of LISA and newer NIV modalities most likely accounts for the reduced failure rate. Gestational age remains the best predictor of NIV failure and is more reliable than the fraction of inspired oxygen during the first hour of life.

Citing Articles

[Risk factors for initial non-invasive ventilation failure in very low birth weight infants with gestational age <32 weeks: a multicenter retrospective study].

Wu W, Rong H, Cheng R, Yang Y, Shen F Zhongguo Dang Dai Er Ke Za Zhi. 2024; 26(9):907-913.

PMID: 39267504 PMC: 11404468. DOI: 10.7499/j.issn.1008-8830.2404166.

Predictors of CPAP failure after less-invasive surfactant administration in preterm infants.

Alsina-Casanova M, Brito N, Balcells-Esponera C, Herranz-Barbero A, Teresa-Palacio M, Soler-Garcia A Front Pediatr. 2024; 12:1444906.

PMID: 39258148 PMC: 11383777. DOI: 10.3389/fped.2024.1444906.

Establishment and Validation of a Risk Prediction Model for Non-Invasive Ventilation Failure After Birth in Premature Infants with Gestational Age < 32 Weeks.

Shen F, Yu M, Rong H, Guo Y, Zou Y, Cheng R Lung. 2024; 202(5):543-552.

PMID: 38958717 DOI: 10.1007/s00408-024-00727-w.

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