Risk Factors Associated With Early-Selective Bubble Nasal Continuous Positive Airway Pressure and Surfactant Failure in Premature Infants With Respiratory Distress Syndrome

Abstract

Background: The aim of the study was to identify significant risk factors associated with early-selective bubble nasal continuous positive airway pressure (BnCPAP) and surfactant failure in preterm infants with respiratory distress syndrome (RDS).

Methods: This was a retrospective cohort study of 344 premature infants with RDS born at the Hospital Universitario de Santander, Bucaramanga, Colombia, between 2006 and 2015. All infants were required to have clinical evidence of progressive respiratory failure, FiO₂ 0.4, and exposure to BnCPAP and surfactant with the INSURE method as initial management for RDS. The primary outcome was the failure of early-selective BnCPAP and INSURE. The incidence of failure was estimated as a cumulative incidence and incidence density ratio. The strength of association with failure was estimated by binomial regression, Kaplan-Meier survival curves, and Coxs regression adjusting for birth weight and gestational age (GA).

Results: Early-selective BnCPAP and INSURE failure occurred in 53/344 patients: a cumulative incidence of failure of 14.9% and an incidence density rate of 3.9/1,000 h of BnCPAP exposure. Risk factors associated with failure were: GA < 28 weeks (relative risk (RR) = 2.62, 95% confidence interval (CI): 1.39 - 4.94) and need for resuscitation with positive pressure ventilation (RR = 1.97, 95% CI: 1.09 - 3.54). Additionally, failure was associated with a higher risk of severe intraventricular hemorrhage and death.

Conclusion: GA < 28 weeks and need for positive pressure ventilation during resuscitation were associated with failure of early-selective BnCPAP and INSURE. Early-selective mechanical ventilation and surfactant therapy should be considered in this subgroup of patients.

Int J Clin Pediatr. 2024;13(2):41-47
doi: https://doi.org/10.14740/ijcp519