The Predictors and Outcomes of Early Noninvasive Positive Pressure Ventilation Failure in Very Preterm Infants: A. Prospective Study
American Journal of Perinatology, cilt.43, sa.4, ss.437-444, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 43 Sayı: 4
- Basım Tarihi: 2026
- Doi Numarası: 10.1055/a-2624-5642
- Dergi Adı: American Journal of Perinatology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO)
- Sayfa Sayıları: ss.437-444
- Anahtar Kelimeler: FiO (2) threshold, noninvasive ventilation, preterm infant
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective Limited data exist on predicting nasal intermittent positive pressure ventilation (NIPPV) failure in very preterm infants. This study aimed to identify factors predicting NIPPV failure, focusing on the fraction of inspired oxygen (FiO 2 ), and evaluating associated outcomes. Study Design This prospective observational study included infants with gestational ages between 23 0/7 and 31 6/7 weeks, who were managed with NIPPV as the initial respiratory support. Infants were categorized as either successfully managed with NIPPV (NIPPV-S) or failed and required intubation within the first 72hours of life (NIPPV-F). Predictors of NIPPV failure and clinical outcomes were evaluated. ROC curve analysis was used to determine FiO 2 thresholds in the first and second hours of life. Demographic, perinatal, and respiratory parameters were analyzed using univariate and multivariate logistic regression models. Results Of the 397 infants, 121 (30.5%) failed NIPPV and required intubation. Multivariate analysis revealed that FiO 2 in the first hour, FiO 2 in the second hour, and mean airway pressure were independent predictors of NIPPV failure. The optimal FiO 2 threshold was 0.32 (sensitivity, 79% and specificity, 50%) for the first hour and 0.31 (sensitivity, 75% and specificity, 55%) for the second hour of life. NIPPV failure was associated with an increased risk of pneumothorax (adjusted odds ratio [aOR]: 16.83; 95% confidence interval [CI]: 2.05–138.45;p<0.001), BPD (aOR: 2.61; 95% CI: 1.47–4.62;p<0.001), and mortality (aOR: 2.37; 95% CI: 1.32–4.23;p<0.001). Conclusion FiO 2 is a valuable predictor of NIPPV success in the early hours of life. NIPPV failure, predicted by a FiO 2 exceeding 0.30 within the first 2hours of life, is associated with adverse neonatal outcomes. Key Points FiO 2 >0.30 in first 2 hours predicts NIPPV failure in very preterm infants. Early NIPPV failure is linked to increased risks of BPD, pneumothorax, and death. FiO 2 and MAP are independent predictors of NIPPV failure.