RISK FACTORS ASSOCIATED WITH PROLONGED MECHANICAL VENTILATION IN VERY LOW BIRTH WEIGHT INFANTS

Abstract

Introduction. Mechanical ventilation (MV) remains a life-saving intervention for the sickest very low birth weight (VLBW) neonates. Despite the widespread use of non-invasive respiratory support, many VLBW neonates require some duration of MV during their initial hospitalization. As prolonged exposure to MV is associated with adverse outcomes in VLBW infants, it is important to identify the factors that influence the duration of this intervention.The study aimed to determine the factors affecting the duration of MV in VLBW infants.Material and methods. Data from a prospectively created computerized database were used in a retrospective cohort study. The database included information on 1086 VLBW infants < 32 weeks' gestation who were ventilated at any time during their hospitalization at the tertiary care hospital between January 2010 and December 2020. Factors that potentially influenced the duration of MV were examined.The research was carried out in compliance with the requirements of bioethics as part of the planned scientific work of the department (state registration number 0117U001083).The data obtained were analyzed using descriptive and comparative statistics, as well as Spearman's rank correlation coefficient and one-way analysis of covariance (ANCOVA). Measurements with normal distribution are presented as mean (standard deviation). Non-parametric continuous data are presented as median (interquartile range). All values were considered significant when p <0.05.The study was carried out as a part of the planned scientific work of the department "Clinical-laboratory and instrumental substantiation of differential approaches to diagnosis, treatment and prevention of childhood diseases" (state registration number 0122U000164) without external sources of funding.Results. According to univariant analysis, bronchopulmonary dysplasia (BPD) (rS=0.32, p<0.05), severe BPD (rS=0.418, p<0.05), pneumothorax (rS=0.06, p=0.05), severe intraventricular hemorrhages (IVH) (rS=0.255, p<0.05), periventricular leukomalacia (PVL) (rS=0.15, p<0.05), sepsis (rS=0.087, p<0.05), necrotizing enterocolitis (rS=0.088, p<0.05), longer duration of antibiotic therapy (rS=0.168, p<0.05), and a lower gestational age (rS=-0.118, p<0.05) were associated with longer duration of MV in VLBW infants. At the same time, BPD (F=18.544, p<0.0001), severe BPD (F=109.810, p<0.0001), severe IVH (F=23.859, p<0.0001), PVL (F=15.031, p<0.0001), and more days of antibiotic therapy (F=13.173, p<0.0001) significantly and independently affected the duration of MV based on the results of one-way ANCOVA.Conclusion. Severe lung and brain injury and prolonged antibiotic exposure were the main risk factors that significantly and independently prolonged MV in VLBW infants.