Fernandez-Gonzalez Sara M, Sucasas Alonso Andrea, Ogando Martinez Alicia, Avila-Alvarez Alejandro
Neonatology Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain.
A Coruña Biomedical Research Institute (INIBIC), 15006 A Coruña, Spain.
Children (Basel). 2022 Mar 17;9(3):426. doi: 10.3390/children9030426.
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 <72 h of life. After applying inclusion and exclusion criteria, 154 patients were included in the study, with a mean GA of 29.7 ± two weeks. The NIV failure rate was 16.2% (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.
无创通气（NIV）现被认为是早产儿呼吸窘迫综合征的一线治疗方法。我们旨在评估极早产儿无创通气失败率，以及确定其预测因素和相关结局。我们设计了一项单中心回顾性队列研究，纳入孕周≤32周且出生体重≤1500g的婴儿。无创通气失败定义为出生后<72小时内需行气管插管。应用纳入和排除标准后，154例患者纳入研究，平均孕周为29.7±2周。无创通气失败率为16.2%（n = 25），且与无支气管肺发育不良（BPD）存活较低（OR 0.08；95%CI 0.02−0.32）及脑室内出血>II级发生率较高（OR 6.22；95%CI 1.36−28.3）相关。这些婴儿的孕周和体重明显较小。复苏期间较高的吸氧浓度（OR 1.14；95%CI 1.06−1.22）及应用表面活性物质后（OR 1.17；95%CI 1.05−1.31）是无创通气失败的独立危险因素。总之，无创通气失败很常见，可通过复苏期间较高的氧需求及对表面活性物质治疗的适度反应来预测。重要的是，这种无创通气失败与更差的临床结局相关。
