Impact of Delayed Initiation of Non-Invasive Ventilation for Respiratory Distress in Outborn Late-Preterm and Term Neonates

The frequency of non-invasive ventilation (NIV) use increased in neonates of all gestational ages with respiratory distress (RD). However, the impact of delayed initiation of NIV support in outborn neonates remains poor understood. The aim of the present study was to identify the impact of delayed initiation of NIV in outborn late-preterm and term neonates. The medical records of 277 infants (gestational age of ≥ 35 weeks) who were received NIV as primary respiratory therapy <24 h of age between 2016 and 2020 were retrospectively reviewed. Among the 190 outborn neonates, the factors associated with respiratory adverse outcomes were investigated. Infants with RD divided into two groups, mild (FiO2 ≤0.3) and moderate-to-severe RD group (FiO2 >0.3), depending on initial oxygen requirement under NIV support. Median time to start of NIV support at tertiary center was 3.5 (2.2–5.0) h. Male sex (odds ratio [OR], 2.9; 95% CI, 1.1–7.7), high oxygen requirement (FiO2 >0.3) (OR, 4.8; 95% CI, 1.5–15.3), and respiratory distress syndrome (OR, 10.4; 95% CI, 3.9–27.8) were the significant factors associated with adverse outcomes. Subgroup analysis revealed that in the moderate-to-severe RD group, delayed initiation of NIV (≥3 h) was significantly associated with pulmonary air leakage (p=0.033).Conclusions: Our study shows that outborn neonates with moderate-to-severe RD who were treated with delayed NIV were associated with an increased likelihood of pulmonary air leakage. Additional prospective studies are needed to establish the optimal timing and methods of NIV support for outborn late-preterm and term infants.