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Risk factors for prolonged respiratory support in late preterm infants: a LASSO-Cox regression analysis

Yu Huang1, Xiao-Shuang Bao1, Na Sun1

  • 1First Affiliated Hospital of Wannan Medical College, Wuhu, China.

Frontiers in Pediatrics
|June 26, 2026
PubMed

Insights

This study identified factors influencing respiratory support duration in late preterm infants. Multiple pregnancies and high superoxide dismutase (SOD) indicate longer support needs, while nasal continuous positive airway pressure (NCPAP) use shortens it.

Area of Science:

  • Neonatal Medicine
  • Respiratory Physiology
  • Predictive Modeling in Pediatrics

Background:

  • Late preterm infants (34 0/7–36 6/7 weeks) often require respiratory support.
  • Predicting the duration of respiratory support is crucial for optimizing care and resource allocation.
  • Interpretable models are needed to guide clinical decision-making for weaning infants from respiratory support.

Purpose of the Study:

  • To identify determinants of respiratory support duration in late preterm infants.
  • To develop and validate an interpretable prediction model for weaning infants from respiratory support.

Main Methods:

  • Retrospective cohort study of 365 late preterm infants.
  • LASSO-Cox regression and multivariable Cox modeling were used to select predictors for respiratory support duration.
  • Model performance was assessed using C-index, time-dependent AUC, calibration curves, and SHAP analysis for interpretability.

Main Results:

  • Risk factors for prolonged respiratory support included multiple pregnancies (HR=1.289) and elevated superoxide dismutase (SOD) (HR=1.014).
  • Protective factors shortening support duration were nasal continuous positive airway pressure (NCPAP) (HR=0.703) and higher lymphocyte percentage (LYM_PC) (HR=0.987).
  • The developed LASSO-Cox nomogram showed moderate-to-good discrimination (C-index=0.677) and acceptable calibration.

Conclusions:

  • Multiple pregnancies and elevated SOD are indicators for prolonged respiratory support needs.
  • Early initiation of NCPAP is associated with shorter respiratory support duration.
  • The interpretable nomogram, enhanced by SHAP values, can aid in individualized weaning assessments for late preterm infants.
Abstract

Keywords:
LASSO-Cox regressionSHAP analysislate preterm infantsnomogramrespiratory supportweaning prediction

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