Early factors associated with continuous positive airway pressure failure in moderate and late preterm infants

To determine the early factors associated with continuous positive airway pressure (CPAP) failure in moderate-to-late preterm infants (32 + 0/7 to 36 +6/7 weeks' gestation) from the NEOBS cohort study. The NEOBS study was a multi-center, prospective, observational study in 46 neonatal intensive care units in France, which included preterm and late preterm infants with early neonatal respiratory distress. This analysis included a subset of the NEOBS population who had respiratory distress and required ventilatory support with CPAP within the first 24 h of life. CPAP failure was defined as the need for tracheal intubation within 72 h of CPAP initiation. Maternal and neonatal clinical parameters in the delivery room and clinical data at 3 h of life were analyzed. CPAP failure occurred in 45/375 infants (12%), and compared with infants with CPAP success, they were mostly singletons (82.2% vs. 62.1%; p <0.01), had a lower Apgar score at 10 min of life (9.1 +/- 1.3 vs. 9.6 +/- 0.8; p = 0.02), and required a higher fraction of inspired oxygen ,(FiO(2); 34.4 +/- 15.9% vs. 22.8 +/- 4.1%; p< 0.0001) and a higher ,FiO(2)* positive end-expiratory pressure (PEEP) (1.8 +/- 0.9 vs. 1.1 +/- 0.3; p <0.0001) at 3 h. FiO(2) value of 0.23 (R-2 = 0.73) and ,FiO(2)* PEEP of 1.50 (R-2 = 0.75) best predicted CPAP failure. The risk of respiratory distress and early CPAP failure decreased 0.7 times per 1-week increase in gestational age and increased 1.7 times with every one-point decrease in Apgar score at 10 min and 19 times with FiO(2)* PEEP> 1.50 (vs. <= 1.50) at 3 h (R-2 of the overall model = 0.83). Conclusion: In moderate-to-late preterm infants, the combination of singleton pregnancy, lower Apgar score at 10 min, and ,FiO(2)* PEEP > 1.50 at 3 h can predict early CPAP failure with increased accuracy.

Automated summary

In moderate-to-late preterm infants, the combination of singleton pregnancy, lower Apgar score at 10 min, and FiO2*PEEP > 1.50 at 3 h can predict early CPAP failure with increased accuracy.