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

IntroductionDespite 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...

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Main Authors: Hector Boix (Author), Cristina Fernández (Author), María del Mar Serrano Martín (Author), Luis Arruza (Author), Ana Concheiro (Author), Ana Gimeno (Author), Ana Sánchez (Author), Segundo Rite (Author), Francisco Jiménez (Author), Paula Méndez (Author), Juan José Agüera (Author), on behalf of the VENTIS study research group (Author)
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Published: Frontiers Media S.A., 2023-02-01T00:00:00Z.
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042 |a dc 
100 1 0 |a Hector Boix  |e author 
700 1 0 |a Cristina Fernández  |e author 
700 1 0 |a María del Mar Serrano Martín  |e author 
700 1 0 |a Luis Arruza  |e author 
700 1 0 |a Ana Concheiro  |e author 
700 1 0 |a Ana Gimeno  |e author 
700 1 0 |a Ana Sánchez  |e author 
700 1 0 |a Segundo Rite  |e author 
700 1 0 |a Francisco Jiménez  |e author 
700 1 0 |a Paula Méndez  |e author 
700 1 0 |a Juan José Agüera  |e author 
700 1 0 |a on behalf of the VENTIS study research group  |e author 
245 0 0 |a 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 
260 |b Frontiers Media S.A.,   |c 2023-02-01T00:00:00Z. 
500 |a 2296-2360 
500 |a 10.3389/fped.2023.1098971 
520 |a IntroductionDespite 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.MethodsThis 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.ResultsThe 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.ConclusionNIV 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. 
546 |a EN 
690 |a respiratory distress syndrome 
690 |a non-invasive respiratory ventilation 
690 |a continuous positive airway pressure 
690 |a preterm infant 
690 |a surfactant 
690 |a less invasive surfactant administration 
690 |a Pediatrics 
690 |a RJ1-570 
655 7 |a article  |2 local 
786 0 |n Frontiers in Pediatrics, Vol 11 (2023) 
787 0 |n https://www.frontiersin.org/articles/10.3389/fped.2023.1098971/full 
787 0 |n https://doaj.org/toc/2296-2360 
856 4 1 |u https://doaj.org/article/ccc33b0b608e4e8fbb27ea4383e86bf5  |z Connect to this object online.