International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access
Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc
Journal website https://www.theijcp.org

Original Article

Volume 13, Number 2, June 2024, pages 41-47

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

Figures

Figure 1.
Figure 1. Risk of survival free of CPAP failure (a) and risk of CPAP failure with corresponding 95% confidence intervals (b). CPAP: continuous positive airway pressure.
Figure 2.
Figure 2. Survival analysis of CPAP failure according to gestational age (a) (P < 0.001) and maternal history of chorioamnionitis (b) (P = 0.002). CPAP: continuous positive airway pressure.
Figure 3.
Figure 3. Survival analysis of CPAP failure according to neonatal sex (a) (P = 0.007) and initial PEEP value (b) (P = 0.083). CPAP: continuous positive airway pressure; PEEP: positive end-expiratory pressure.
Figure 4.
Figure 4. Survival analysis of CPAP failure according to need for resuscitation (a) (P = 0.014) and weight at birth (b) (P = 0.040). CPAP: continuous positive airway pressure; PPV: positive pressure ventilation.

Tables

Table 1. INSURE Failure Incidence According to Maternal Prenatal Exposures
 
VariableCategoryFailure (%)aP-value
aFailure with early-selective BnCPAP and INSURE. BnCPAP: bubble nasal continuous positive airway pressure; PROM: premature rupture of membranes.
DeliveryVaginal13/73 (17.8%)0.522
C-section40/271 (14.8%)
Gestational age (weeks)< 287/15 (46.7%)0.001
28 - 29.613/60 (21.7%)
≥ 3033/269 (123%)
Maternal diabetesYes1/6 (16.7%)0.931
No52/338 (15.4%)
Pregnancy hypertensive disorderYes13/83 (15.7%)0.941
No40/261 (15.4%)
PROMYes8/69 (11.6%)0.326
No45/275 (16.4%)
Urinary tract infectionYes9/39 (23.0%)0.159
No44/305 (14.4%)
ChorioamnionitisYes13/49 (26.5%)0.020
No40/295 (13.6%)
Antenatal corticoids courseNone19/112 (17.0%)0.667
Incomplete19/113 (16.8%)
Complete15/119 (12.6%)

 

Table 2. Failure Rate of Early-Selective BnCPAP and INSURE According to Year and Neonatal Demographics
 
VariableCategoryFailure (%)aP-value
aFailure on early-selective BnCPAP and INSURE. BnCPAP: bubble nasal continuous positive airway pressure; GA: gestational age.
Failure yeara< 200823/104 (22.0%)0.270
2009 - 201118/132 (13.6%)
> 201212/108 (11.0%)
Birth weight (g)< 1,0008/18 (44.4%)0.003
1,000 - 1,49922/132 (16.7%)
1,500 - 1,99920/161 (12.4%)
≥ 2,0003/33 (9.1%)
According to GAAdequate48/320 (15.0%)0.595
Small3/17 (17.7%)
Large2/7 (17.7%)
SexFemale16/146 (11.0%)0.055
Male37/198 (18.7%)

 

Table 3. BnCPAP and INSURE Failure Incidence According to Postnatal Clinical Characteristics
 
VariableCategoryINSURE failureP-value
CC: chest compression; PEEP: positive end-expiratory pressure; PPV: positive pressure ventilation.
Apgar score at 5 min7 - 1049/328 (15.0%)0.276
4 - 64/16 (25.0%)
Need for resuscitationNone14/154 (9.1%)0.009
PPV only36/178 (20.2%)
PPV + CC1/8 (12.5%)
PPV + CC + medication2/4 (50.0%)
PneumoniaYes17/68 (25.0%)0.014
No36/276 (13.0%)
Initial PEEP (cm H2O)443/308 (14.0%)0.043
56/26 (23.0%)
64/10 (40.0%)

 

Table 4. Incidence of Secondary Outcomes According to INSURE Success or Failure
 
Secondary outcomeTotal patients (n = 344)INSURE outcomeP-value
Success (n = 291)Failure (n = 53)
IVH: intraventricular hemorrhage; NEC: necrotizing enterocolitis.
Chronic pneumopathy48 (14.0%)37 (12.7%)11 (20.7%)0.120
IVH grade III or IV6 (1.7%)1 (0.3%)5 (9.4%)< 0.001
NEC17(4.5%)15 (5.1%)2 (3.7%)0.670
Air leak syndrome7 (2.0%)5 (1.7%)2 (3.8%)0.330
Sepsis100 (29.1%)80 (27.5%)20 (37.7%)0.131
Death20 (5.8%)14 (4.8%)6 (11.3%)0.063