Objective To investigate the risk factors and adverse prognosis associated with initial non-invasive ventilation (NIV) failure in very low birth weight infants (VLBWI) with gestational age <32 weeks. Methods A retrospective collection of clinical data from preterm infants admitted to the neonatal intensive care unit (NICU) in 28 tertiary hospitals in Jiangsu Province from January 2019 to December 2021 was conducted. Based on the outcomes of initial NIV, the infants were divided into a successful group and a failure group to analyze the risk factors for NIV failure and adverse prognosis. Results A total of 817 infants were included, with 453 males (55.4%) and 139 failures (17.0%). The failure group had lower gestational age, birth weight, and 1-minute and 5-minute Apgar scores compared to the successful group (P<0.05). The failure group also had a higher proportion of respiratory distress syndrome (RDS) diagnosed upon NICU admission, higher maximum positive end-expiratory pressure during NIV, and higher percentages of reaching the required maximum fraction of inspired oxygen (FiO2) ≥30%, ≥35%, and ≥40% throughout the initial NIV process compared to the successful group (P<0.05). Gestational age (OR=0.671, 95%CI: 0.581-0.772), RDS (OR=1.955, 95%CI: 1.181-3.366), and FiO2 ≥30% (OR=2.053, 95%CI: 1.106-4.044) were identified as risk factors for initial NIV failure in these infants with gestational age <32 weeks (P<0.05). The failure group had higher incidences of complications such as pulmonary infections, pneumothorax, retinopathy of prematurity, moderate to severe bronchopulmonary dysplasia, and severe intraventricular hemorrhage during hospitalization, as well as longer hospital stays and higher total costs compared to the successful group (P<0.05). Conclusions Smaller gestational age, a diagnosis of RDS in the NICU, and achieving a maximum FiO2 ≥30% during the initial NIV process are risk factors for initial NIV failure in infants with gestational age <32 weeks. Initial NIV failure significantly increases the risk of adverse outcomes in this population.
Key words
Non-invasive ventilation /
Failure /
Risk factor /
Preterm infant /
Very low birth weight infant
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References
1 Committee on Fetus and Newborn, American Academy of Pediatrics. Respiratory support in preterm infants at birth[J]. Pediatrics, 2014, 133(1): 171-174. PMID: 24379228. DOI: 10.1542/peds.2013-3442.
2 Sweet DG, Carnielli VP, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome: 2022 update[J]. Neonatology, 2023, 120(1): 3-23. PMID: 36863329. PMCID: PMC10064400. DOI: 10.1159/000528914.
3 中国医师协会新生儿科医师分会. 早产儿呼吸窘迫综合征早期防治专家共识[J]. 中华实用儿科临床杂志, 2018, 33(6): 438-440. DOI: 10.3760/cma.j.issn.2095-428X.2018.06.010.
4 Avila-Alvarez A, Zozaya C, Pértega-Diaz S, et al. Temporal trends in respiratory care and bronchopulmonary dysplasia in very preterm infants over a 10-year period in Spain[J]. Arch Dis Child Fetal Neonatal Ed, 2022, 107(2): 143-149. PMID: 34321246. DOI: 10.1136/archdischild-2021-322402.
5 Dargaville PA, Gerber A, Johansson S, et al. Incidence and outcome of CPAP failure in preterm infants[J]. Pediatrics, 2016, 138(1): e20153985. PMID: 27365307. DOI: 10.1542/peds.2015-3985.
6 Dargaville PA, Aiyappan A, De Paoli AG, et al. Continuous positive airway pressure failure in preterm infants: incidence, predictors and consequences[J]. Neonatology, 2013, 104(1): 8-14. PMID: 23595061. DOI: 10.1159/000346460.
7 Fernandez-Gonzalez SM, Sucasas Alonso A, Ogando Martinez A, et al. Incidence, predictors and outcomes of noninvasive ventilation failure in very preterm infants[J]. Children (Basel), 2022, 9(3): 426. PMID: 35327798. PMCID: PMC8947251. DOI: 10.3390/children9030426.
8 Boix H, Fernández C, Serrano Martín MDM, et al. 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[J]. Front Pediatr, 2023, 11: 1098971. PMID: 36896404. PMCID: PMC9989254. DOI: 10.3389/fped.2023.1098971.
9 多中心极低出生体重儿预后评估协作组. 极早产儿初始无创持续气道正压呼吸支持失败的多中心队列研究[J]. 中华儿科杂志, 2021, 59(4): 273-279. PMID: 33775045. DOI: 10.3760/cma.j.cn112140-20201117-01034.
10 余霞娟, 熊小云, 曹慧玲, 等. 加温湿化高流量鼻导管通气在新生儿初始呼吸支持治疗失败的危险因素分析[J]. 中国医刊, 2023, 58(3): 340-344. DOI: 10.3969/j.issn.1008-1070.2023.03.031.
11 杜坐平, 肖传絮, 曾义协, 等. 早产儿加温湿化高流量经鼻导管通气初始呼吸支持失败的危险因素分析[J]. 中国当代儿科杂志, 2021, 23(9): 896-902. PMID: 34535203. PMCID: PMC8480159. DOI: 10.7499/j.issn.1008-8830.2107017.
12 中华医学会儿科学分会新生儿学组. 早产儿无创呼吸支持临床应用建议[J]. 中华儿科杂志, 2018, 56(9): 643-647. PMID: 30180400. DOI: 10.3760/cma.j.issn.0578-1310.2018.09.002.
13 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
14 徐丛剑, 华克勤. 实用妇产科学[M]. 4版. 北京: 人民卫生出版社, 2018.
15 杨洋, 卢刻羽, 程锐, 等. 不同维持剂量枸橼酸咖啡因对辅助通气早产儿的疗效评估: 一项初步多中心研究[J]. 中国当代儿科杂志, 2022, 24(3): 240-248. PMID: 35351252. PMCID: PMC8974660. DOI: 10.7499/j.issn.1008-8830.2109144.
16 Wright CJ, Sherlock LG, Sahni R, et al. Preventing continuous positive airway pressure failure: evidence-based and physiologically sound practices from delivery room to the neonatal intensive care unit[J]. Clin Perinatol, 2018, 45(2): 257-271. PMID: 29747887. PMCID: PMC5953203. DOI: 10.1016/j.clp.2018.01.011.
17 范雪, 陈娟. 160例初始持续气道正压通气早产儿的临床分析[J]. 华西医学, 2016, 31(11): 1833-1836. DOI: 10.7507/1002-0179.201600503.
18 De Jaegere AP, van der Lee JH, Canté C, et al. Early prediction of nasal continuous positive airway pressure failure in preterm infants less than 30 weeks gestation[J]. Acta Paediatr, 2012, 101(4): 374-379. PMID: 22150698. DOI: 10.1111/j.1651-2227.2011.02558.x.
19 Rocha G, Fl?r-de-Lima F, Proen?a E, et al. Failure of early nasal continuous positive airway pressure in preterm infants of 26 to 30 weeks gestation[J]. J Perinatol, 2013, 33(4): 297-301. PMID: 22935774. DOI: 10.1038/jp.2012.110.
20 Gulczyńska E, Szczapa T, Ho?ejowski R, et al. Fraction of inspired oxygen as a predictor of CPAP failure in preterm infants with respiratory distress syndrome: a prospective multicenter study[J]. Neonatology, 2019, 116(2): 171-178. PMID: 31112987. PMCID: PMC6878744. DOI: 10.1159/000499674.
21 Glaser K, Wright CJ. Indications for and risks of noninvasive respiratory support[J]. Neonatology, 2021, 118(2): 235-243. PMID: 33902052. PMCID: PMC8178193. DOI: 10.1159/000515818.
22 Tagliaferro T, Bateman D, Ruzal-Shapiro C, et al. Early radiologic evidence of severe respiratory distress syndrome as a predictor of nasal continuous positive airway pressure failure in extremely low birth weight newborns[J]. J Perinatol, 2015, 35(2): 99-103. PMID: 25188910. DOI: 10.1038/jp.2014.164.
23 中国医师协会新生儿科医师分会, 中国医院协会妇产医院管理分会围产医学学组, 中国妇幼保健协会新生儿保健专业委员会. 极早产儿产房过渡期管理专家共识[J]. 中华围产医学杂志, 2022, 25(6): 401-411. DOI: 10.3760/cma.j.cn113903-20220108-00027.
24 Kakkilaya V, Wagner S, Mangona KLM, et al. Early predictors of continuous positive airway pressure failure in preterm neonates[J]. J Perinatol, 2019, 39(8): 1081-1088. PMID: 31089256. DOI: 10.1038/s41372-019-0392-z.
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