Association of delayed initiation of non-invasive respiratory support with pulmonary air leakage in outborn late-preterm and term neonates
- Authors
- Choi, Eui Kyung; Park, Kyu Hee; Choi, Byung Min
- Issue Date
- 4월-2022
- Publisher
- SPRINGER
- Keywords
- Respiratory distress syndrome; Outborn; Newborn; Continuous positive airway pressure
- Citation
- EUROPEAN JOURNAL OF PEDIATRICS, v.181, no.4, pp.1651 - 1660
- Indexed
- SCIE
SCOPUS
- Journal Title
- EUROPEAN JOURNAL OF PEDIATRICS
- Volume
- 181
- Number
- 4
- Start Page
- 1651
- End Page
- 1660
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/141106
- DOI
- 10.1007/s00431-021-04317-3
- ISSN
- 0340-6199
- Abstract
- The frequency of non-invasive respiratory support use has increased in neonates of all gestational ages with respiratory distress (RD). However, the impact of delayed initiation of non-invasive respiratory support in outborn neonates remains poorly understood. This study aimed to identify the impact of the delayed initiation of non-invasive respiratory support in outborn, late-preterm, and term neonates. Medical records of 277 infants (gestational age of >= 35 weeks) who received non-invasive respiratory support as primary respiratory therapy < 24 h of age between 2016 and 2020 were retrospectively reviewed. Factors associated with respiratory adverse outcomes were investigated in 190 outborn neonates. Infants with RD were divided into two groups: mild (fraction of inspired oxygen [FiO(2)] <= 0.3) and moderate-to-severe RD (FiO(2) > 0.3), depending on their initial oxygen requirements from non-invasive respiratory support. The median time for the initiation of non-invasive respiratory support at a tertiary center was 3.5 (2.2-5.0) h. Male sex, a high oxygen requirement (FiO(2) > 0.3), high CO2 level, and respiratory distress syndrome were significant factors associated with adverse outcomes. Subgroup analysis revealed that in the moderate-to-severe RD group, delayed commencement of non-invasive respiratory support (>= 3 h) was significantly associated with pulmonary air leakage (p = 0.033). Conclusion: Our study shows that outborn neonates with moderate-to-severe RD, who were treated with delayed non-invasive respiratory support, were associated with an increased likelihood of pulmonary air leakage. Additional prospective studies are required to establish the optimal timing and methods of non-invasive respiratory support for outborn, late-preterm, and term infants. What is Known: center dot Non-invasive respiratory support is widely used in neonates of all gestational ages. center dot Little is known on the impact of delayed initiation of non-invasive respiratory support in outborn, late preterm, and term neonates. What is New: center dot Male sex, high oxygen requirement (FiO2 >0.3), high initial CO2 level, and respiratory distress syndrome significantly correlated with adverse outcomes. center dot Outborn late-preterm and term neonates with high oxygen requirement who were treated with delayed non-invasive respiratory support indicated an increased likelihood of pulmonary air leakage.
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