Risk factors for noninvasive ventilation failure in preterm infants at less than 30 weeks of gestation with respiratory distress syndrome

This study aimed to identify risk factors for noninvasive ventilation (NIV) failure in <30 weeks’ gestation preterm neonates and compare morbidity in patients with and without NIV failure. This study included preterm neonates <30 weeks’ gestation who received NIV support for respiratory distress syndrome (RDS). Demographic and clinical characteristics were compared between infants with and without NIV failure within the first 72 hours after birth. Of 443 preterm neonates, NIV failure occurred in 101 (22.8%). Of these, initial respiratory support was nasal continuous positive airway pressure (nCPAP) in 76 infants (75.2%) and nasal intermittent positive pressure ventilation (NIPPV) or bilevel positive airway pressure (BiPAP) in 25 infants (24.8%). Gestational age, birth weight, and antenatal steroid exposure were significantly lower in patients with NIV failure. Grade III-IV intraventricular hemorrhage, moderate/severe bronchopulmonary dysplasia, and retinopathy of prematurity requiring laser photocoagulation were significantly more common in the NIV failure group. Multivariate logistic regression analysis showed that antenatal steroid therapy reduced NIV failure [odds ratio (OR): 0.53, 95% confidence interval (CI): 0.29–0.94; P = .03], while nCPAP (OR: 2.61, 95% CI: 1.53–4.48; P < .001), surfactant requirement (OR: 2.40, 95% CI: 1.36–4.25; P = .003), and ≥2 doses of surfactant need (OR: 3.57, 95% CI: 1.89–6.74; P < .001) were associated with greater NIV failure. The results of this study indicated that administering antenatal steroids and using NIPPV or BiPAP instead of nCPAP as initial respiratory support reduced the likelihood of NIV failure in preterm infants with RDS.