Zhu J, Li S S, Gao Y, Han S P
Department of Neonatology, Lianyungang Maternal and Child Health Hospital, Lianyungang222000, China.
Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing210004, China.
Zhonghua Er Ke Za Zhi. 2024 Dec 2;62(12):1176-1183. doi: 10.3760/cma.j.cn112140-20240513-00326.
To investigate the risk factors of initial non-invasive ventilation(NIV) failure and its association with adverse outcomes in very low birth weight infants (VLBWI). A retrospective cohort study was conducted, collecting clinical data of 2 102 VLBWI who received NIV within 30 minutes after birth, admitted to 18 NICU of Suxinyun Neonatal Perinatal Collaboration Network (SNPN) from January 1, 2019 to December 31, 2022. According to the outcome of NIV within the first 72 hours, the study cohort was divided into success group and failure group. Univariate analysis and multivariate Logistic regression analysis were performed to identify risk factors for NIV failure and its association with adverse outcome. A total of 2 102 VLBWI were included, consisting of 1 078 males (51.3%). The gestational age was 29 (28, 31) weeks, and the birth weight was 1 250 (1 090, 1 380) g. The initial NIV failure rate was 15.3%(321/2 102). Multivariate Logistic regression analysis showed that smaller gestational age (=0.67, 95% 0.61-0.74, 0.001), maternal hypertensive disorders during pregnancy (=10.31, 95% 7.48-14.21, <0.001), Apgar score at the first minute ≤7 (=1.40, 95% 1.01-1.93, 0.042), grade 3-4 respiratory distress syndrome (RDS)(=2.85, 95% 1.69-4.81, <0.001), ≥2 times pulmonary surfactant (PS) treatment (=3.78, 95% 2.09-6.83, <0.001), fraction of inspired oxygen (FiO)>0.30 (=2.21, 95% 1.64-2.98, <0.001) were all independent risk factors for initial NIV failure. The failure group had higher risks of mortality (=10.19, 95% 6.50-15.97, 0.001), pneumothorax (4.33, 95% 1.59-11.79, =0.004), neonatal pulmonary hemorrhage (=8.48, 95% 4.08-17.64, <0.001), moderate to severe bronchopulmonary dysplasia (BPD)(=1.75, 95% 1.19-2.56, =0.004), and intraventricular hemorrhage (IVH) ≥grade Ⅲ (2.18, 95% 1.27-3.73, =0.004) compared to the success group. Small gestational age, maternal hyertensive disorders during pregnancy, Apgar score at the first minute ≤7, grade 3-4 RDS, PS treatment ≥2 times and FiO >0.30 are risk factors for initial NIV failure in VLBWI. Initial NIV failure is associated with increased risk of mortality, pneumothorax, pulmonary hemorrhage, moderate to severe BPD, and IVH ≥grade Ⅲ.
探讨极低出生体重儿（VLBWI）初始无创通气（NIV）失败的危险因素及其与不良结局的关系。进行一项回顾性队列研究，收集2019年1月1日至2022年12月31日在苏新云新生儿围产期协作网络（SNPN）的18个新生儿重症监护病房（NICU）出生后30分钟内接受NIV的2102例VLBWI的临床资料。根据前72小时内NIV的结局，将研究队列分为成功组和失败组。进行单因素分析和多因素Logistic回归分析，以确定NIV失败的危险因素及其与不良结局的关系。共纳入2102例VLBWI，其中男性1078例（51.3%）。胎龄为29（28，31）周，出生体重为1250（1090，1380）g。初始NIV失败率为15.3%（321/2102）。多因素Logistic回归分析显示，较小的胎龄（β=0.67，95%CI 0.61-0.74，P<0.001）、孕期母亲高血压疾病（β=10.31，95%CI 7.48-14.21，P<0.001）、1分钟Apgar评分≤7分（β=1.40，95%CI 1.01-1.93，P=0.042）、3-4级呼吸窘迫综合征（RDS）（β=2.8
