Even while advancements in neonatal-perinatal care have increased newborn survival at ever younger gestational ages, extremely preterm infants still face grave risks of illness or death. Bronchopulmonary dysplasia, a dangerous illness characterised by underdeveloped lungs, is the major cause of mortality in young newborns.
Noninvasive respiratory support at birth, as opposed to immediate intubation and delivery of lung surfactant, has been found to improve short-term respiratory outcomes in preterm infants delivered between 24 weeks 0 days and 27 weeks 6 days of gestation.
Full-term pregnancy lasts between 39 and 40 weeks.
In one of the largest studies of this population, UAB researchers conducted a retrospective analysis of 230 consecutively born, eligible nano-preterm infants born at the UAB level IV neonatal intensive care unit between January 2014 and June 2021. 88 infants in the noninvasive group were intubated more than 10 minutes after birth, whereas 142 newborns in the invasive group were intubated within 10 minutes of birth. Lal and colleagues observed no benefits for the noninvasive respiratory support of nano-preterm newborns, as defined by the composite endpoint of bronchopulmonary dysplasia or death by 36 weeks postmenstrual age, in contrast to several earlier studies of slightly older preterm infants.
By 36 weeks, 94.3 percent of the noninvasive group and 90.9% of the invasive group had bronchopulmonary dysplasia or had died. This difference was not statistically significant. The physicians did see that severe intraventricular haemorrhage or death at 36 weeks was reduced in the invasive respiratory assistance group, a result that will need to be confirmed with a larger sample size.
The average weight of noninvasive nano-preterm infants was 1 pound, 4 ounces, while that of invasive preterm infants was 1 pound, 2 ounces.
Shukla, V.V., et al. (2022) Hospital and neurodevelopmental outcomes in nano-preterm infants receiving invasive vs noninvasive ventilation at birth. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2022.29105