Incidence, Predictors and Outcomes of Noninvasive Ventilation Failure in Very Preterm Infants

Abstract

Non-invasive ventilation (NIV) is now considered the first-line treatment for respiratory distress syndrome in preterm infants. We aimed to evaluate the rates of non-invasive ventilation failure rate in very preterm infants, as well as to identify its predictors and associated outcomes. We designed a single-center retrospective cohort study including infants ≤32 weeks gestational age and ≤1500 g. The NIV failure was defined as the need for intubation at n = 25) and it was associated with lower bronchopulmonary dysplasia (BPD)-free survival (OR 0.08; 95% CI 0.02–0.32) and higher incidence of intraventricular hemorrhage > II (OR 6.22; 95% CI 1.36–28.3). These infants were significantly smaller in GA and weight. Higher FiO2 during resuscitation (OR 1.14; 95% CI 1.06–1.22) and after surfactant administration (OR 1.17; 95% CI 1.05–1.31) represented independent risk factors for NIV failure. In conclusion, NIV failure is frequent and it could be predicted by a higher oxygen requirement during resuscitation and a modest response to surfactant therapy. Importantly, this NIV failure is associated with worse clinical outcomes.

Keywords

• continuous positive airway pressure
• hyaline membrane disease
• noninvasive ventilation
• prematurity and respiratory distress syndrome