Abstract: Objective To analysis the cause and adverse outcome of initial noninvasive continuous positive airway pressure failure in very/extremely low weight(VLBW/ELBW)infants. Methods A total of 153 VLBW/ELBW infants with the birth wight <1.50 kg and gestational age<32.0 weeks in Shandong Provincial Hospital Affiliated to Shandong 山 东 大 学 学 报 (医 学 版)57卷4期 -王莉,等.153例极/超低出生体重儿初始无创持续气道正压通气失败的不良预后及关联性因素分析 \=- University from January 1, 2016 to September 30, 2017 were enrolled. The infants were divided into noninvasive-S group(n=126), in which the noninvasive support was successful, and noninvasive-F group(n=27), in which the noninvasive support was failed. In-hospital outcomes, including survival rate, pneumorrhagia, pneumothorax, intracranial hemorrhage, late-onset sepsis(LOS), neonatal necrotizing enterocolitis(NEC), bronchopulmonary dysplasia(BPD), retinopathy of prematurity(ROP)and extrauterine growth retardation(EUGR), were compared between the two groups. Logistic regression models were used to further investigate the perinatal factors associated with noninvasive failure and its correlation with the adverse outcomes during hospitalization of the infants. Results The gestation age, birth weight, perinatal asphyxia and EOS were statistical different between the two groups(P<0.05), and the Logistic regression analysis showed that birth weight and perinatal asphyxia were associated with noninvasive failure(P<0.05). The ROC analysis showed that birth weight <1.17 kg was the most significant cutoff value for the development of noninvasive failure with sensibility being 0.78, specificity being 0.71, and area under the curve being 0.80, P<0.001. Logistic regression analysis for short-outcome showed that the death rate, pneumorrhagia, LOS and ROP were statistical different between the two groups(P<0.05). The two crucial causes of death were pneumorrhagia and intracranial hemorrhage in noninvasive-F group, and the gestational age of the dead infants caused by pneumorrhagia was 29.6(26.8, 30.3)weeks and birth weight was 0.80(0.74, 1.11)kg. Conclusion The rate of noninvasive failure was 17.6% in VLBW /ELBW infants, and lower birth weight(<1.17 kg)and perinatal asphyxia are associated with noninvasive failure. Noninvasive failure in preterm infants is associated with death, pneumorrhagia, LOS, and ROP. The leading causes of death are pneumorrhagia, especially for the infants with birth weight ≤0.80 kg, and intracranial hemorrhage.

Key words: Very low birth weight infants, Extremely low birth weight infants, Noninvasive continuous positive airway pressure, Outcome