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Published on: August 25, 2014
Hospital and Neurodevelopmental Outcomes in Nano-Preterm Infants Receiving Invasive vs Noninvasive Ventilation at
Vivek V Shukla1, J Paige Souder2, Grant Imbrock1
1Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham.
Insights
Noninvasive respiratory support for nano-preterm infants is feasible but does not reduce bronchopulmonary dysplasia or death risk compared to early intubation. Invasive support showed a lower incidence of severe intraventricular hemorrhage or death.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Perinatology
Background:
- Infants born between 22 0/7 and 23 6/7 weeks' gestational age (nano-preterm) face high risks of adverse outcomes.
- Noninvasive respiratory support benefits infants born at later gestations (24 0/7–27 6/7 weeks), but evidence for nano-preterm infants is limited.
Purpose of the Study:
- To test if early intubation (≤10 minutes post-birth) increases bronchopulmonary dysplasia (BPD) or death by 36 weeks' postmenstrual age (PMA) in nano-preterm infants.
- To compare outcomes between noninvasive and invasive respiratory support strategies initiated at birth for this high-risk group.
Main Methods:
- Observational cohort study of 230 nano-preterm infants (22 0/7–23 6/7 weeks' GA) at a level IV NICU (2014–2021).
- Infants were grouped by first intubation timing: >10 minutes (noninvasive support) vs. ≤10 minutes (invasive support).
- Primary outcome: composite of BPD (physiologic definition) or death by 36 weeks' PMA.
Main Results:
- The incidence of BPD or death by 36 weeks' PMA did not differ significantly between noninvasive (94.3%) and invasive (90.9%) support groups (aOR, 2.09; P=.24).
- Invasive respiratory support was associated with a lower incidence of severe intraventricular hemorrhage or death by 36 weeks' PMA (aOR, 2.20; P=.03).
- Nano-preterm infants in the noninvasive group had a median GA of 23.6 weeks, while the invasive group had a median GA of 23.0 weeks.
Conclusions:
- Noninvasive respiratory support is feasible in the first 10 minutes for nano-preterm infants but does not decrease the risk of BPD or death compared to early intubation.
- Early intubation and surfactant delivery may be a viable strategy for this extremely preterm population, potentially reducing severe intraventricular hemorrhage.
Importance:
Infants with gestational age between 22 0/7 and 23 6/7 weeks (referred to as nano-preterm infants) are at very high risk of adverse outcomes. Noninvasive respiratory support at birth improves outcomes in infants born at 24 0/7 to 27 6/7 weeks' gestational age. Evidence is limited on whether similar benefits of non-invasive respiratory support at birth extend to nano-preterm infants.
Objective:
To evaluate the hypothesis that intubation at 10 minutes or earlier after birth is associated with a higher incidence of bronchopulmonary dysplasia (BPD) or death by 36 weeks' postmenstrual age (PMA) in nano-preterm infants.
Design, Setting, And Participants:
This observational cohort study included all nano-preterm infants at a level IV neonatal intensive care unit who were delivered from January 1, 2014, to June 30, 2021. Infants receiving palliative or comfort care at birth were excluded.
Exposures:
Infants were grouped based on first intubation attempt timing after birth (>10 minutes after birth and ≤10 minutes as noninvasive and invasive respiratory support at birth groups, respectively).
Main Outcomes And Measures:
The primary outcome was the composite outcome of BPD (physiological definition) or death by 36 weeks' PMA.
Results:
All 230 consecutively born, eligible nano-preterm infants were included, of whom 88 (median [IQR] gestational age, 23.6 [23.4-23.7] weeks; 45 [51.1%] female; 54 [62.1%] Black) were in the noninvasive respiratory support at birth group and 142 (median [IQR] gestational age, 23.0 [22.4-23.3] weeks; 71 [50.0%] female; 94 [66.2%] Black) were in the invasive respiratory support at birth group. The incidence of BPD or death by 36 weeks' PMA did not differ between the noninvasive and invasive respiratory support groups (83 of 88 [94.3%] in the noninvasive group vs 129 of 142 [90.9%] in the invasive group; adjusted odds ratio, 2.09; 95% CI, 0.60-7.25; P = .24). Severe intraventricular hemorrhage or death by 36 weeks' PMA was lower in the invasive respiratory support at birth group (adjusted odds ratio, 2.20; 95% CI, 1.07-4.51; P = .03).
Conclusions And Relevance:
This cohort study's findings suggest that noninvasive respiratory support in the first 10 minutes after birth is feasible but is not associated with a decrease in the risk of BPD or death compared with intubation and early surfactant delivery in nano-preterm infants.
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