Original ArticlePredictors and Outcomes of Early Intubation in Infants Born at 28-36 Weeks of Gestation Receiving Noninvasive Respiratory Support
Section snippets
Methods
Between 2013 and 2015 we performed the HIPSTER trial: an international, multicenter, randomized, noninferiority trial in preterm infants born at 28-36 weeks of gestation that compared nHF 6-8 L/min with CPAP 6-8 cm H2O as primary support for early respiratory distress.20 Infants were eligible if they were <24 hours old, had not previously received endotracheal ventilation or surfactant treatment, and the attending clinician had decided to commence or continue noninvasive support. Infants were
Results
All 564 infants included in the randomized trial were included in this analysis. The mean (SD) gestational age and birth weight of this cohort were 32.0 (2.2) weeks and 1744 (589) g, and 289 infants (51.2%) were very preterm. Antenatal glucocorticoids were administered to the mothers of 453 infants (80.6%), and 404 births (71.6%) were by cesarean delivery. The median age at randomization was 1.4 hours (IQR, 0.7-2.8 hours) and 323 infants (57.3%) had received CPAP treatment (median, 1.5 hours;
Discussion
In a cohort of preterm infants who participated in a large, multicenter RCT of primary noninvasive support, lower gestational age and higher pre-randomization FiO2 predicted the need for intubation and mechanical ventilation within 72 hours. Infants who were intubated spent a median of 6 days longer on respiratory support and 5 days longer on oxygen therapy, and were more likely to have a pneumothorax and nasal trauma. Very preterm infants who were intubated had a 6-fold increase in the risk of
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Perinatal care for the extremely preterm infant
2022, Seminars in Fetal and Neonatal MedicineCitation Excerpt :Although non-invasive ventilation has been developed, data from both RCTs and observational reports demonstrate that within the first week of life, approximately 50% of infants initially supported with CPAP require IMV [168–170,186]. Gestational age appears to be a strong predictor of failure, with the most immature neonates failing at the highest rates [187,188]. As the first sustained pressure and inspiratory time of EPI are not enough to clear lung fluid and establish functional residual capacity (FRC), sustained lung inflation (SLI) using positive pressure (∼20–25 cm H2O for 5–20 s) were considered to prevent non-invasive ventilation failure [189].
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2023, Journal of Evidence-Based Medicine
Supported by he National Health and Medical Research Council (NHMRC), Australia (No. 1079089, 1060733, and 1153176). C.R. is supported by the Monash University Kathleen Tinsley Research Fellowship. B.M. is supported by a Medical Research Future Fund (Australia) Next Generation Clinical Researchers Career Development Fellowship (MRF1159225). L.O. is supported by a National Health and Medical Research Council (NHMRC) Career Development Fellowship (No. 1159444). P.D. and C.R. have received travel support from Fisher and Paykel. The other authors declare no conflicts of interest.