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Identifying Factors Associated with Prolonged Postoperative Mechanical Ventilation in Preterm Infants Undergoing

Qiang Gao1, Yu Cao2, Xiwang Liu1

  • 1Department of Cardiac Surgery & Heart Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child and Adolescents' Health and Diseases, Hangzhou 310052, China.

Journal of Clinical Medicine
|July 15, 2026
PubMed

Insights

High Respiratory Severity Score (RSS) and low birth weight predict prolonged mechanical ventilation (MV) after patent ductus arteriosus (PDA) ligation in preterm infants. This helps identify high-risk neonates needing closer monitoring.

Area of Science:

  • Neonatal Medicine
  • Pediatric Surgery
  • Respiratory Physiology

Background:

  • Patent ductus arteriosus (PDA) is common in preterm infants and often requires surgical ligation.
  • Prolonged mechanical ventilation (MV) post-ligation is a significant complication, impacting outcomes.
  • Identifying factors predicting prolonged MV is crucial for optimizing care.

Purpose of the Study:

  • To analyze factors associated with prolonged MV after PDA ligation in preterm infants.
  • To identify high-risk neonates requiring closer perioperative monitoring.
  • To utilize machine learning for predictive factor analysis.

Main Methods:

  • Retrospective analysis of preterm infants (≤32 weeks) undergoing PDA ligation (2021-2025).
  • Analysis of demographic, preoperative, and postoperative data.
  • Application of machine learning and SHAP analysis to identify predictive factors.

Main Results:

  • Significant differences in gestational age, birth weight, RSS, and post-ligation cardiac syndrome were observed between short (<6 days) and prolonged (>6 days) MV groups.
  • Respiratory Severity Score (RSS) > 4.5 was the strongest predictor of prolonged MV (AUC = 0.865).
  • Low birth weight and slow postoperative heart rate were associated with increased MV duration, while higher birth weight and heart rate correlated with shorter duration.

Conclusions:

  • High RSS, low birth weight, and slow postoperative heart rate are key indicators for prolonged MV after PDA ligation.
  • These factors can assist in identifying preterm infants at higher risk for extended ventilation.
  • Targeted monitoring and intervention for high-risk infants may improve outcomes.

Keywords:
machine learningmechanical ventilationpatent ductus arteriosuspreterm infantsrisk factors

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