Related Experiment Video
Updated: Nov 8, 2025
Development of a Neonatal Piglet Acute Lung Injury Model Recreating the Early Environment of Preterm Infant Lungs
Published on: October 31, 2025
Predictor Factors of Continuous Positive Airway Pressure Failure in Preterm Infants with Respiratory Distress
Winda Intan Permatahati1, Amalia Setyati1, Ekawaty Lutfia Haksari1
1Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Insights
Nasal continuous positive airway pressure (CPAP) failure is common in preterm infants with respiratory distress. Low birth weight (<1000g), high initial Downes score, and needing high oxygen levels (FiO2 >30%) predict CPAP failure.
Area of Science:
- Neonatology
- Pediatric Respiratory Medicine
- Critical Care
Background:
- Respiratory distress is a major cause of mortality and morbidity in preterm infants.
- Nasal continuous positive airway pressure (CPAP) is a common treatment, but failure rates are high.
- Data on nasal CPAP failure in Indonesia are limited, necessitating further research.
Purpose of the Study:
- To identify predictive factors for nasal CPAP failure in preterm infants experiencing respiratory distress.
- To provide a reference for preventive strategies aimed at reducing infant mortality and morbidity.
Main Methods:
- Retrospective cohort study of preterm infants with respiratory distress.
- Data collected from January 2017 to July 2019 at Dr. Sardjito Hospital's Neonatology ward.
- Statistical analysis included Chi-square/Fisher's exact tests and multivariate logistic regression.
Main Results:
- Out of 150 infants, 37.8% experienced nasal CPAP failure.
- Significant predictors identified by multivariate analysis were: birth weight <1000g (OR 2.69), initial Downes score (OR 2.68), and initiation of FiO2 requirement ≥30% (OR 3.03).
- Bivariate analysis also indicated singleton birth, APGAR score 4-7, and premature rupture of membranes as risk factors.
Conclusions:
- Birth weight <1000g, high initial Downes score, and requirement for FiO2 ≥30% are significant predictors of nasal CPAP failure in preterm infants.
- These findings can inform clinical practice and targeted interventions to improve CPAP success rates.
- Further research is needed to validate these predictors and develop effective management protocols.
Abstract:
Respiratory distress contributes significantly to mortality, and morbidity in preterm infants. The incidence of nasal continuous positive airway pressure (CPAP) failure is remarkably high. There are limited data available regarding nasal CPAP failure in Indonesia, and this study is expected to be a reference in taking preventive measures to reduce mortality and morbidity in preterm infants. To determine predictive factors of nasal CPAP failure in preterm infants with respiratory distress. A retrospective cohort study was conducted in preterm infants with respiratory distress at the Neonatology ward of Dr. Sardjito Hospital during January 2017-July 2019. Chi-square or Fisher's exact tests, followed by multivariate logistic regression analysis with backward method, was used to identify factors contributing to nasal CPAP failure. A total of 150 infants were included in this study. Fifty-three (37.8%) infants had nasal CPAP failure. Bivariate analysis showed birth weight <1000 g, singleton, APGAR score 4-7, premature rupture of membrane (PROM), Downes score, and initiation of fractional concentration of inspired (FiO2) requirement were all risk factors of nasal CPAP failure. However, only birth weight <1000 g (P = .022; OR 2.69; CI 95% 1.34-5.44), initial Downes score (P = .035; OR 2.68; CI 95% 3.10-24.11), and initiation of FiO2 requirement ≥30% (P = .0001; OR 3.03; CI 95% 2.04-4.50) were significant predictors for nasal CPAP failure by multivariate analysis. Birth weight <1000 g, singleton, initial Downes score, and initiation of FiO2 requirement >30% were significant predictors of nasal CPAP failure in preterm infants with respiratory distress.
Related Concept Videos
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...
01:19Factors Affecting Pulmonary Ventilation
Alveolar Surface Tension
The alveolar fluid lines the luminal surface of the alveoli and exerts a force called surface tension. This force is caused by the polar water molecules in the liquid being more strongly attracted to each...
01:30Acute Respiratory Failure-III
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:23Acute Respiratory Failure-IV
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include: