Noninvasive Respiratory Support or Intubation during Stabilization after Birth and Neonatal and Neurodevelopmental Outcomes in Infants Born Preterm at 23-25 Weeks of Gestation
R. Lipp, Marc Beltempo, Abhay Lodha, Dany E. Weisz, Julie McKanna, Ian Matthews, M. Florencia Ricci, Matthew Hicks, Amina Benlamri, Amit Mukerji, Ruben Alvaro, Eugene Ng, Thuy Mai Luu, Prakesh S. Shah, Ayman Abou Mehrem, Marc Beltempo, Prakesh S. Shah, Thevanisha Pillay, Jonathan Wong, Miroslav Stavel, Rebecca Sherlock, Ayman Abou Mehrem, Jennifer Toye, Joseph Ting, Carlos Fajardo, Andrei Harabor, Lannae Strueby, Mary Seshia, Deepak Louis, Chelsea Ruth, Ann Yi, Amit Mukerji, Orlando da Silva, Sajit Augustine, Kyong‐Soon Lee, Sajit Augustine, Brigitte Lemyre, Brigitte Lemyre, Faiza Khurshid, Victoria Bizgu, Nina Nouraeyan, Keith J. Barrington, Anie Lapointe, Christine Drolet, Martine Claveau, Marie St‐Hilaire, Valérie Bertelle, Édith Massé, Caio Barbosa de Oliveira, Hala Makary, Gabriela de Carvalho Nunes, Wissam Alburaki, Jo-Anna Hudson, Jehier Afifi, Andrzej Kajetanowicz, Jehier Afifi, Wendy Whittle, Swati Agarwal, Kenneth Lim, Jessica Liauw, Darine El‐Chaâr, Katherine Thériault, Marie‐Ève Roy‐Lacroix, Kimberly Butt, Candace O’Quinn, Alberta Christy Pylypjuk, Isabelle Boucoiran, Catherine Taillefer, Joan Crane, Haim A. Abenhaim, Graeme N. Smith, Karen Wou, Sue Chandra, Jagdeep Ubhi, Ernesto Antônio Figueiró-Filho, Michael Helewa, A Grigoriu, Rob Gratton, Cynthia Chan, Gabriela de Caralho Nunes, Ludmila Porto, Nir Melamed, Jason Burrows, Sajit Augustine, Lara Wesson, Erin MacLellan, James Hayward, Victoria M. Allen, Thevanisha Pillay, Jessie VanDyk, Rebecca Sherlock, Miroslav Stavel, Anitha Moodley, Leonora Hendson, Amina Benlamri, Amber Reichert, Amy Shafey, Diane Moddemann, Cecilia de Cabo, M. Florencia Ricci
Abstract
OBJECTIVE: To examine the association between noninvasive respiratory support (NRS) or tracheal intubation (TI) during stabilization in infants born at 23-25 weeks of gestation and severe brain injury (sBI) or death, and significant neurodevelopmental impairment (sNDI). STUDY DESIGN: weeks of gestation in Canada. We compared infants successfully managed with NRS or TI during 30 minutes after birth. The primary outcomes were sBI or death before discharge, and sNDI among survivors with follow-up data at 18-24 months corrected age. The associations between exposures and outcomes were assessed using logistic regression models, and propensity score-matched analyses. RESULTS: The mean (SD) of gestational age and birth weight were 24.6 (0.6), 24.3 (0.7) weeks [P < .01], and 757 (173), 705 (130) grams [P < .01] in the NRS, and tracheal intubation (TI) groups, respectively, and 77% of infants in the NRS group were intubated by 7 days of age. sBI or death occurred in 25% (283/1118), and 36% (722/2012) of infants in the NRS and TI groups, respectively (aOR and 95% CI 0.74 [0.60, 0.91]). Among survivors with follow-up data, sNDI occurred in 17% (96/551), and 23% (218/937) of infants in the NRS and TI groups, respectively (aOR [95% CI] 0.77 [0.60, 0.99]). In the propensity score-matched analyses (NRS vs TI), results were consistent for sBI or death (OR [95% CI] 0.72 [0.60, 0.86]), but not for sNDI (OR [95% CI] 0.78 [0.58, 1.05]). CONCLUSIONS: Infants born at 23-25 weeks who were successfully managed with NRS, compared with TI, in the first 30 minutes after birth had lower odds of sBI or death before discharge, but had no significant differences in neurodevelopmental outcomes among survivors.