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Outcomes of preterm infants receiving positive pressure support at term corrected gestation

Aoife McMorrow1, Cameron Smirk, Peter G Davis

  • 1The Royal Women's Hospital, Melbourne, Victoria, Australia; Royal Jubilee Maternity Hospital, Belfast, Northern Ireland.

Journal of Paediatrics and Child Health
|October 19, 2013
PubMed

Insights

Two-thirds of very preterm infants on positive pressure support (PPS) at term corrected gestation survived. Higher oxygen needs at term significantly increased mortality risk for these infants.

Area of Science:

  • Neonatal Medicine
  • Pediatric Critical Care
  • Respiratory Physiology

Background:

  • Very preterm infants often require respiratory support.
  • Continued positive pressure support (PPS) at term corrected gestation indicates significant respiratory compromise.
  • Mortality rates for this vulnerable population require further investigation.

Purpose of the Study:

  • To determine the mortality rate until hospital discharge for very preterm infants requiring positive pressure support (PPS) at term corrected gestation.
  • To identify factors associated with increased mortality in this cohort.

Main Methods:

  • Retrospective review of infants born <30 weeks' gestation receiving PPS at 40 weeks' postmenstrual age (PMA).
  • Data collected included fraction of inspired oxygen (FiO2), mean airway pressure, and partial pressure of carbon dioxide (PaCO2).
  • Receiver operating characteristic (ROC) curves were used to assess predictors of mortality.

Main Results:

  • Of 49 infants on PPS at 40 weeks' PMA, 15 (31%) died before discharge.
  • Increased oxygen requirement (FiO2 > 0.5) was associated with an 80% risk of death (AUC 0.75).
  • Endotracheal ventilation and high FiO2 (>0.70) were associated with 100% mortality.

Conclusions:

  • The majority (two-thirds) of very preterm infants on PPS at 40 weeks' PMA survived to hospital discharge.
  • Increasing oxygen requirements at term are a significant risk factor for mortality.
  • Close monitoring and management of oxygenation are critical for this population.
Abstract

Keywords:
mortalitypositive pressure supportpreterm

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