Factors associated with long-term mechanical ventilation in extremely preterm infants.

BACKGROUND: The objective of this study was to determine factors associated with long-term intermittent positive pressure ventilation (IPPV) in extremely preterm infants.

METHODS: Study setting was a ten bed pod (SBP) part of the Level IV all referral NICU, dedicated to the care of infants born at <27 weeks and which utilizes a protocol-driven approach to care. All admissions to the SBP from 2005 to 2011 were included if admitted in the first week of life and alive at 56 days of age.

RESULTS: There were 210 patients and 35% were on IPPV for ≥56 days (for the purposes of this study defined as long-term IPPV). Long-term IPPV patients were born earlier, had lower birth weight, were admitted later, and more likely to come from a level III NICU. LTV patients were more likely to have a PDA ligation, receive dopamine, receive TPN longer, and receive supplemental oxygen at 36 weeks PMA. In logistic regression modeling transfer from another Level III NICU (OR 3.7, 95% CI 1.5-9.2, p = 0.006) and recieveing dopamine (OR 3.1, 95% CI 1.5-6.3, p = 0.002) were associated with long-term IPPV.

CONCLUSIONS: In this cohort of infants born at <27 weeks gestation 35% were on long term IPPV. There are identifiable factors known on admission and occurring during the NICU stay that are associated with long-term IPPV.