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Association of delayed initiation of non-invasive respiratory support with pulmonary air leakage in outborn late-preterm and term neonates

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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 [FiO2] ≤ 0.3) and moderate-to-severe RD (FiO2 > 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 (FiO2 > 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:

• Non-invasive respiratory support is widely used in neonates of all gestational ages.

• Little is known on the impact of delayed initiation of non-invasive respiratory support in outborn, late preterm, and term neonates.

What is New:

• Male sex, high oxygen requirement (FiO2 >0.3), high initial CO2 level, and respiratory distress syndrome significantly correlated with adverse outcomes.

• 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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Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Abbreviations

BiPAP:

Biphasic positive airway pressure

CPAP:

Continuous positive airway pressure

DR:

Delivery room

FiO2 :

Fraction of inspired oxygen

HHFNC:

Humidified high flow nasal cannula

NICU:

Neonatal intensive care unit

NIPPV:

Nasal intermittent positive pressure ventilation

NPPV:

Non-invasive positive pressure ventilation

NRP:

Neonatal resuscitation program

OR:

Odds ratio

PEEP:

Positive end-expiratory pressure

RD:

Respiratory distress

RDS:

Respiratory distress syndrome

SD:

Standard deviation

S/F:

Peripheral saturation/FiO2 ratio

sNIPPV:

Synchronized nasal intermittent positive pressure ventilation

Ti:

Inspiratory time

TTN:

Transient tachypnea of the newborn

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Authors and Affiliations

  1. Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea

    Eui Kyung Choi, Kyu Hee Park & Byung Min Choi

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  1. Eui Kyung Choi
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Contributions

Eui Kyung Choi: Primary author, Data collection, Data analysis, Manuscript writing. Kyu Hee Park: Data collection. Byung Min Choi: Drafting of the manuscript, Editing, Critical revision of the manuscript, Responsible for the overall content. All authors provided contributions, read, and approved the final version.

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Correspondence to Byung Min Choi.

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This study was approved by the Institutional Research Ethics Committee of the Korea University Ansan Hospital (2021AS0193).

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Patient consent was waived due to retrospective study design.

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Written informed consent for publication was obtained from all authors.

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The authors declare no competing interests.

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Communicated by Daniele De Luca

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Choi, E.K., Park, K.H. & Choi, B.M. Association of delayed initiation of non-invasive respiratory support with pulmonary air leakage in outborn late-preterm and term neonates. Eur J Pediatr 181, 1651–1660 (2022). https://doi.org/10.1007/s00431-021-04317-3

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