Noninvasive respiratory support in the first 10 minutes after birth for infants with a gestational age between 22 and 23 weeks is feasible but may be associated with increased incidence of severe intraventricular hemorrhage or death, according to study findings published in JAMA Network Open.
For infants born between 24- and 27-weeks’ gestational age, noninvasive respiratory support at birth improves outcomes; however, little is known regarding noninvasive support for younger infants with a gestational age between 22 and 23 weeks (ie, nano-preterm infants). Researchers investigated whether intubation at 10 minutes or earlier after birth was associated with a higher incidence of bronchopulmonary dysplasia (BPD) or death by 36 weeks’ PMA in nano-preterm infants.
An observational cohort study enrolled 230 consecutively born nano-preterm infants at a level IV neonatal intensive care unit delivered between January 1, 2014, and June
30, 2021. Infants receiving palliative or comfort care were excluded from analysis. Overall, 88 of 230 infants were in the noninvasive respiratory support at birth group and 142 in the invasive support at birth group.
There was no difference in the incidence of BPD or death by 36 weeks’ postmenstrual age between groups (83 of 88 [94.3%] vs 129 of 142 [90.9%]; adjusted odds ratio [aOR], 2.09; 95% CI, 0.60-7.25; P =.24). For infants in the invasive support group the incidence of severe intraventricular hemorrhage or death by 36 weeks’ PMA was lower (aOR, 2.20; 95% CI, 1.07-4.51; P =.03).
Study limitations include the single center and retrospective study design and the fact that baseline characteristics favored infants in the noninvasive support group.
According to researchers, “An adequately powered trial is needed to confirm the trends for better short-term outcomes in the invasive respiratory support at birth group seen in the current study.”
Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Shukla VV, Souder JP, Imbrock G, et al. Hospital and neurodevelopmental outcomes in nano-preterm infants receiving invasive vs noninvasive ventilation at birth. JAMA Netw Open. 2022; 5(8):e2229105. doi:10.1001/jamanetworkopen.2022.29105.