268 - Outcomes following Non-invasive Respiratory Support Failure in Moderately Preterm Infants

Publication Number: 268.5622

Jacob J. Elliott, University of Wisconsin School of Medicine and Public Health, Cross Plains, WI, United States; Dinushan Kaluarachchi, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Patrick J. Peebles, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Jens Eickhoff, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Jennifer Brady, Unitypoint-Meriter, Madison, WI, United States; Megan M. Christensen, University of Wisconsin School of Medicine and Public Health, Fitchburg, WI, United States; Kimberly Wentela, Unitypoint Health - Meriter, Madison, WI, United States

Background: Noninvasive respiratory support (NRS) is critical in initial management of preterm neonates with respiratory distress syndrome (RDS). Many neonates fail NRS and require advanced support within the first days of life. Data on outcomes following NRS failure in moderate preterm neonates is limited, particularly its impact on length of NICU stay.

Objective: To evaluate the association between NRS failure and short term NICU outcomes. We hypothesized that neonates who develop NRS failure have a longer NICU stay.

Design/Methods: A retrospective cohort study of infants born between 290/7 and 336/7weeks with RDS admitted to UnityPoint Health Meriter NICU between 1/1/2017- 12/31/2020. Neonates intubated in the first 2 hours of life or those who didn’t require respiratory support were excluded. The cohort was divided into two groups; NRS failure and NRS success. NRS failure was defined as administration of surfactant and/or need for mechanical ventilation in the first 72 hours of life. Surfactant typically administered when FiO2 reached 30-40% on CPAP of 6-7 cm H20. Univariate analysis was performed to compare characteristics and outcomes between the two groups and a multivariable logistic regression analysis was performed to evaluate the primary outcome of length of stay controlling for relevant variables.

Results: 267 neonates were included. 21% developed NRS failure. Neonates who failed NRS were less likely to receive antenatal steroids, and more likely to be born to mothers with chorioamnionitis (Table 1). NRS failure was associated with higher rates of pneumothorax, bronchopulmonary dysplasia, duration of total respiratory support (Table 2). Neonates who failed NRS had a longer length of stay, but this was not statistically significant (p=0.05). After adjusting for gestational age, gender, birthweight percentile, and antenatal steroid exposure, a generalized estimating equation analysis was used to account for twins/triplet births. There was no significant difference in length of stay between the two groups (OR 1.01, CI 0.99-1.04, P=0.33).

Conclusion(s): NRS failure was associated with multiple adverse short term NICU outcomes. However, NRS failure in moderate preterm neonates was not associated with increased length of stay. These findings should be replicated in large multi-center studies. We also propose that future studies should evaluate the effects of NRS failure on late preterm infants born at gestational ages of 34-36 weeks.

Table 1. Characteristics of the study cohort


Table 2. Primary and Secondary outcomes


Table 1. Characteristics of the study cohort


Table 2. Primary and Secondary outcomes