Effect of different courses and durations of invasive mechanical ventilation on respiratory outcomes in very low birth weight infants
Authors: Yang Yang , Gu Xin-yue , Lin Zhen-lang , Pan Shu-lin , Sun Jian-hua , Cao Yun , Lee Shoo K. , Wang Jian-hui , Cheng Rui ,   the CHNN investigators, Lee Shoo K. , Chen Chao , Du Lizhong , Zhou Wenhao , Cao Yun , Chen Xiuyong , Zhang Huayan , Tian Xiuying , Ji Yong , Li Zhankui , Yi Bing , Yang Chuanzhong , Liu Ling , Fu Jianhua , Wang Sannan , Chen Dongmei , Yang Changyi , Gang Xirong , Cheng Rui , Wu Hui , Shan Ruobing , Han Shuping , Pan Xinnian , Dai Yiheng , Wang Lili , Qiu Gang , Li Mingxia , Jiang Hong , Kang Wenqing , Shi Yuan , Liu Jiangqin , Zhou Qin , Feng Xing , Pan Jiahua , Li Long , Xia Hongping , Lin Zhenlang , Chen Pingyang , Zhang Qin , Xu Falin , Yang Ling , Lin Xinzhu , Li Xiaoying , Ma Li , Zhuang Deyi , Sun Jianhua , Liang Kun , Qiu Yinping , Zhong Xiaoyun , Feng Jinxing , Chen Liping , Hei Mingyan , Dong Wenbin , Huang Huiwen , Yin Zhaoqing , Li Li , Yang Jie , Zhang Liyan , Song Hongxia , Wang Huaiyan , Li Yanhong , Wang Jimei , Mi Hongying , Li Dong , Zeng Linkong , Zhu Hongdan , Zhang Qianshen , Ding Guofang , Gao Yan , Wang Hongyun , Wang Zhen , Zhen Hong , Ma Xiaolu , Wu Fang , Ting Joseph 
Published: November 2023

This multicenter retrospective study was conducted to explore the effects of different courses and durations of invasive mechanical ventilation (MV) on the respiratory outcomes of very low birth weight infants (VLBWI) in China. The population for this study consisted of infants with birth weight less than 1500 g needing at least 1 course of invasive MV and admitted to the neonatal intensive care units affiliated with the Chinese Neonatal Network within 6 h of life from January 1st, 2019 to December 31st, 2020. Univariate and multivariate logistic regression analyses were performed to evaluate associations between invasive MV and respiratory outcomes. Adjusted odds ratios (ORs) were computed with the effects of potential confounders. (1) Among the 3183 VLBWs with a history of at least one course of invasive MV, 3155 (99.1%) met inclusion criteria and were assessed for the primary outcome. Most infants received one course (76.8%) and a shorter duration of invasive MV (62.16% with ventilation for 7 days or less). (2) In terms of the incidence of all bronchopulmonary dysplasia (BPD) (mild, moderate, and severe BPD), there were no significant differences between different invasive MV courses [For 2 courses, adjusted OR = 1.11 (0.88, 1.39); For 3 courses or more, adjusted OR = 1.07 (0.72, 1.60)]. But, with the duration of invasive MV prolonging, the OR of BPD increased [8–21 days, adjusted OR = 1.98 (1.59, 2.45); 22–35 days, adjusted OR = 4.37 (3.17, 6.03); ≥ 36 days, adjusted OR = 18.44 (10.98, 30.99)]. Concerning severe BPD, the OR increased not only with the course of invasive MV but also with the duration of invasive MV [For 2 courses, adjusted OR = 2.17 (1.07, 4.40); For 3 courses or more, adjusted OR = 2.59 (1.02, 6.61). 8–21 days, adjusted OR = 8.42 (3.22, 22.01); 22–35 days, adjusted OR = 27.82 (9.08, 85.22); ≥ 36 days, adjusted OR = 616.45 (195.79, > 999.999)]. (3) When the interaction effect between invasive MV duration and invasive MV course was considered, it was found that there were no interactive effects in BPD and severe BPD. Greater than or equal to three courses would increase the chance of severe BPD, death, and the requirement of home oxygen therapy. Compared with distinct courses of invasive MV, a longer duration of invasive MV (> 7 days) has a greater effect on the risk of BPD, severe BPD, death, and the requirement of home oxygen therapy.