Neonatal Intensive Unit Research Articles

Family-centered care in neonatal intensive units: The perceptions of nursing technicians

Enquadramento: O cuidado centrado na criança e na família (CCCF) em unidades neonatais possui diversos benefícios como diminuir o sofrimento dos pais pela sua participação e autonomia, aumento do aleitamento materno, diminuição de sequelas da prematuridade. Objetivo: Compreender as conceções de técnicos de enfermagem sobre o CCCF praticado em unidade de terapia intensiva neonatal (UTIN). Metodologia: Investigação qualitativa desenvolvida em UTIN de um hospital-escola localizado no interior de São Paulo, Brasil, com entrevistas abertas e semiestruturadas junto a seis técnicos de enfermagem. Os dados foram analisados por análise temática, à luz dos pressupostos do CCCF. Resultados: Foram encontrados seis temas - Incluir a família no cuidado, Promover a aproximação da unidade familiar, Acolher a unidade familiar, Partilha de informações com a família, Reconhecer a UTIN como ambiente stressor à família e Limitações para oferecer o CCCF na UTIN. Conclusão: O estudo evidenciou limitações na compreensão do CCCF pelos profissionais de enfermagem e a necessidade de incluir o assunto na formação dos futuros profissionais e em atividades de educação continuada.

Parental stress in the neonatology unit - The influence of hospital stay length and neonatal unit differentiation

AimTo analyze the influence of neonatal unit differentiation and hospital stay length on parental stress. BackgroundParents choose to deliver in a private or public hospital. These hospitals differ in the specialization in perinatal care and the support offered by the neonatal units. MethodsIt was a methodological study. Data were collected using the Neonatal Unit Parental Stress Scale - Portuguese version that was given to parents on day 2, and day 14 of hospitalization after the child's birth. ResultsIn the Parent Relationship with Infant and Parental Role and Physical Environment and Sounds dimensions, there was an increase in parental stress in differentiated neonatal intensive units and a decrease in stress in specialized and special neonatal units. ConclusionParents should be integrated into activities that promote their parental role, and actions should be implemented to reduce stressors in the neonatal unit environment.

Clinical applicability of Nursing Outcomes related to breastfeeding establishment in the Neonatal Intensive Care Unit

Objective: to analyze clinical changes in the breastfeeding process in the Neonatal Intensive Unit Care using the Nursing Outcomes Classification. Methods: this longitudinal and prospective study was conducted in a public hospital at Neonatal Intensive Unit Care in Brazil. The sample consisted of 61 mother-infant dyads evaluated three times during breastfeeding by trained nurses who applied the Nursing Outcomes Classification scales. Statistical analysis was performed using Generalized Estimating Equation Models. Results: most indicators of the two Nursing Outcomes studied presented a similar frequency of scores of 4 and 5. It was observed that in most indicators, there were clinical changes throughout the evaluations over time; however, the indicators related to the mother presented a higher risk of scoring 4 and 5 on the Likert scale. Conclusion: the Nursing Outcomes Classification outcomes and indicators included successfully evaluated the clinical evolution of mother-infant dyads and proved to be applicable for use in Neonatal Intensive Unit Care. Contributions to practice: nurses can use the indicators to assess the quality and accuracy of the proposed interventions.

A protocol of drug and infusion fluid: Preparation, administration, compatibility and stability in neonatal intensive unit care

A protocol of drug and infusion fluid: Preparation, administration, compatibility and stability in neonatal intensive unit care

Neonatal Renovascular Hypertension in a Pediatric Patient due to Occult Renal Artery Thrombosis: A Case Report

Renovascular Hypertension (RVH) is the most common cause of neonatal hypertension seen in Neonatal Intensive Units (NICU) [1]. It accounts for 5-25% of childhood hypertension [2] and is the most common cause of surgically correctable hypertension.

Prevalence and Molecular Typing of Carbapenemase-Producing Enterobacterales among Newborn Patients in Italy.

The spread of carbapenemase-producing Enterobacterales (CPE), especially Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli), is a serious public health threat in pediatric hospitals. The associated risk in newborns is due to their underdeveloped immune system and limited treatment options. The aim was to estimate the prevalence and circulation of CPE among the neonatal intensive units of a major pediatric hospital in Italy and to investigate their molecular features. A total of 124 CPE were isolated from rectal swabs of 99 newborn patients at Bambino Gesù Children’s Hospital between July 2016 and December 2019. All strains were characterized by antimicrobial susceptibility testing, detection of resistance genes, and PCR-based replicon typing (PBRT). One strain for each PBRT profile of K. pneumoniae or E. coli was characterized by multilocus-sequence typing (MLST). Interestingly, the majority of strains were multidrug-resistant and carried the blaNDM gene. A large part was characterized by a multireplicon status, and FII, A/C, FIA (15%) was the predominant. Despite the limited size of collection, MLST analysis revealed a high number of Sequence Types (STs): 14 STs among 28 K. pneumoniae and 8 STs among 11 E. coli, with the prevalence of the well-known clones ST307 and ST131, respectively. This issue indicated that some strains shared the same circulating clone. We identified a novel, so far never described, ST named ST10555, found in one E. coli strain. Our investigation showed a high heterogeneity of CPE circulating among neonatal units, confirming the need to monitor their dissemination in the hospital also through molecular methods.

Challenges of uptake of kangaroo mother care by parents of preterm and low birth weight infants in Edo State, Nigeria.

The uptake of kangaroo mother care (KMC) which is acclaimed to be an effective and efficient method of neonatal survival has not increased in Edo State even more than a decade since its recommendation by the WHO in Edo State. Nigeria ranks seventh among the ten African countries where newborns have the highest risk of dying with over 700 newborn deaths per10, 000 live births. The study investigated the challenges faced by parents of preterm and low birth weight infants in the uptake of KMC. The design was an exploratory qualitative research design that utilized semi-structured interviews with open-ended questions to interview 13 mothers whose premature babies were admitted in the neonatal intensive unit of a tertiary health facility. Responses were analyzed thematically and reported in codes and themes. Findings: all participants reported similar challenges, which included ridicule from untrusting friends, inadequate information, lack of human and material resources and nurses' poor attitude. Recommendations made were timely information, increase in human and material resources and establishment of KMC dedicated centers by government.

Hypertension in pregnancy and adverse outcomes among low-risk nulliparous women expectantly managed at or after 39weeks: a secondary analysis of a randomised controlled trial.

To evaluate whether hypertensive disorders of pregnancy (HDP) among low-risk nulliparous women expectantly managed at or after 39weeks of gestation are associated with adverse outcomes. Secondary analysis of a randomised trial. Multicentre, USA. Individuals in the expectantly managed group who delivered on or after 39weeks. Multivariable analysis to estimate adjusted relative risks (aRR) for binomial outcomes, adjusted odds ratios (aOR) for multinomial outcomes and 95% CI. Composite adverse maternal outcome including placental abruption, pulmonary oedema, postpartum haemorrhage, postpartum infection, venous thromboembolism or intensive care unit admission. Secondary outcomes included a composite of perinatal death or severe neonatal complications, mode of delivery, small and large for gestational age and neonatal intermediate or intensive unit length of stay. Of the 3044 women randomised to expectant management in the original trial, 2718 (89.3%) were eligible for this analysis, of whom 373 (13.7%) developed HDP. Compared with participants who remained normotensive, those who developed HDP were more likely to experience the maternal composite (12% versus 6%, aRR 1.84, 95% CI 1.33-2.54) and caesarean delivery (29% versus 23%, aOR 1.32, 95% CI 1.01-1.71). Differences between the two groups were not significantly different for the adverse perinatal composite (7% versus 5%, aRR 1.38, 95% CI 0.92-2.07) or for other secondary outcomes. Almost 14% of low-risk nulliparous individuals expectantly managed at 39weeks developed HDP, and were more likely to experience adverse maternal outcomes compared with those who did not develop HDP. Almost 14% of low-risk nulliparous individuals expectantly managed at 39 weeks developed hypertensive disorders of pregnancy, and were more likely to experience adverse maternal outcomes compared with those who did not develop hypertensive disorders.

Bronchopulmonary dysplasia: Incidence and severity in premature infants born at high altitude

Bronchopulmonary dysplasia (BPD) is the most common cause of chronic lung disease in children born prematurely. There is little information about the epidemiology and severity of BPD places with high altitude. This study aimed to evaluate the frequency of BPD severity levels and the associated risk factors with severity in a cohort of preterm newborns ≤36weeks of gestational age born in Rionegro, Colombia MATERIALS AND METHODS: We carried out a retrospective analytical cohort of preterm newborns without major malformations from Rionegro, Colombia between 2011 and 2018 admitted to neonatal intensive unit at high altitude (2200 m above sea level). The main outcomes were the incidence and severity of BPD. The BPD incidence was 23.5% 95% (confidence interval [CI], 19.6-27.7). BPD was grade 1 in 69.9%, grade 2 in 15.5% and grade 3 in 14.5% of patients. After modeling regression analysis, the final variables associated with BPD severity levels were: sepsis (odds ratio [OR], 4.15; 95% CI, 1.33-12.96) and pulmonary hypertension (OR: 3.86; 95% CI, 1.30-11.4). The incidence of BPD was higher and similar to cities with higher altitudes. In our population, the variables associated with BPD severity levels were: sepsis and pulmonary hypertension. It is necessary to increase the awareness of risk factors, the effect of clinical practices, and early recognition of BPD to reduce morbidity in patients with this pathology.

Elective caesarean section after 39 weeks gestation and the influence on neonatal morbidity: Does a strict policy really help?

Purpose: The aim of the current study was to determine if the decision to strictly follow clinical guidelines recommending elective caesarean section at or after 39 weeks gestation (late– term) in an effort to reduce respiratory disorders in term neonates influence the incidence of early–term elective caesarean sections and the rate of neonatal respiratory disorders.
 Methods: Hospital records pertaining to elective caesarean section after 37 weeks gestation from 1 January 2007 to 31 December 2016 were analyzed. Two subgroups were established (“before” and “after”). The rate of elective caesarean section before 39 weeks gestation, the rate of neonatal respiratory disorders, and admissions to the neonatal intensive care unit were compared between the subgroups.
 Results: A total of 1881 elective caesarean sections were performed from 37 weeks gestation (1.083 [57.6%] in the before sub–group and 798 [42.4%] in the after sub– group). In the after sub–group there was a 9.8% reduction of procedures performed before 39 weeks gestation. Of the newborns, 1.59% had various respiratory problems (2.3% and 1.00% in the before and after sub–groups, respectively; p = 0.08). Six of 30 (20.0%) newborns were transferred to the neonatal intensive unit (4/22 [18.2%] and 2/8 [25.0%] in the before and after sub–groups, respectively).
 Conclusion: The policy reduced the rate of elective caesarean sections before 39 weeks gestation and the rate of neonatal respiratory disorders, even though the incidence of these disorders was rather low, even before the new policy.

Improving Care in Neonatal Intensive Units During the COVID-19 Pandemic: A Survey on Electronic Health Communication.

Background: A novel virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started spreading through Italy and the world from February 2020, and the pandemic threatened the family-centred care (FCC) model used in the neonatal intensive care unit (NICU). Teleconferences and video calls were employed to keep parents in contact with their babies. This study aimed to evaluate satisfaction and stress levels between parents in the telematic family-centred care group (T-FCC) versus the FCC group and the no Family-Centred Care (N-FCC) group. Methods A prospective cohort pilot study was carried out from April to May 2020. A parental stressor scale and the NICU satisfaction questionnaire were administered to parents at the time of discharge of their newborns. Parents in T-FCC group could see their newborns via video calls, while those in the FCC and N-FCC groups were extracted from our previously published database. Results Parents in the T-FCC group were more satisfied and less stressed than those in the N-FCC group. Experiences of the mothers and fathers in the T-FCC group were similar. However, the FCC group showed the best results. Conclusion The T-FCC group showed satisfaction with the quality of information received about their babies and felt that their privacy was considered and respected by the medical staff. Parents were also less stressed because they could monitor what happens to the baby through a video, however, they could not intervene if there was a problem. Data support the use of video calls to improve insight into clinical conditions and communication between doctors, nurses, and parents during the pandemic.

'Wherever you are, my son, wait for me.' study on medically assisted reproduction

Abstract Introduction In Italy the use of Medically Assisted Procreation (MAP) is increasingly frequent also because the mean age at which Italian women have their first child has increased in recent decades (31.8 years in 2017) and it is more difficult to have a child for an older woman. The aim of this study was evaluate the maternal and neonatal outcomes of MAP and compare them with those of natural pregnancies. Methods The cross-sectional study was performed during the period January 2015-June 2019. All women that gave birth in the Hospital of Siena were included. The sample was divided in two groups (Natural pregnancy/MAP Pregnancy). The outcome variables were: maternal age, number of foetus, type of childbirth, timing of the birth, Apgar Index and necessity of hospitalization in neonatal intensive therapy unit (NITU) or resuscitation. The statistical analysis was performed with Stata 12. Results In total 5066 females were included (4.5% MAP pregnancy). The average age (±SD) of females was 32,9±5,56 (min 14-max 61). The mean age (±SD) of women with PMA was significantly higher 38.7 ± 5.7 vs. 32.6± 5.4 of those who had natural pregnancy. In PMA Pregnancy there was a higher probability of multiple pregnancy (OR = 16.13; 95% CI 10.38-25.07; p < 0.001), Caesarean Section (OR:4,54; 95% CI 3.28-6.31; p < 0,001) and preterm birth (OR 3.79; 95% IC 2.80-5.14; p < 0.001). Apgar index at the first minute was significantly lower in children born from pregnancies from MAP (8,6 ±1,4 vs, 9 ±1,4 p < 0.01), the difference was significant even in the 5th minute (9,6 ±0,7 vs. 9,8 ±0,6 p < 0.01). Children born by MAP Pregnancy had higher probability of hospitalization in Neonatal Intensive Care (OR = 3.12; 95% CI 2.12-4.59; p < 0.001). Conclusions In our sample we found that MAP is used by women with older average age and it is associated with less favourable maternal and neonatal outcomes than those from natural conception. Key messages In Italy the use of Medically Assisted Procreation (MAP) is increasingly frequent because it is more difficult to have a child for an older woman. In our sample we found that MAP is used by women with older average age and it is associated with less favourable maternal and neonatal outcomes than those from natural conception.

VP31.24: Preterm Caesarean section in a pregnant woman infected with COVID‐19

Since the outbreak of COVID-19 disease in 2019, many reports have been describing the pregnancy situation among COVID-19 positive patients. We report a pregnant woman in whom early medical management for pneumonia due to COVID-19 and Caesarean section leads to saving the life of both mother and infant. The patient was a 37-year-old Iranian woman, gravida 1, with a singleton pregnancy, at 32 weeks and 6 days of gestation. She was previously healthy without any prior comorbid diagnosis. Her body mass index (BMI) was 30. Because of dyspnea, fever, and a positive COVID-19 RT PCR test, the patient was transferred to our tertiary centre on April 13, 2021. At admission time, O2 saturation was 98% with oxygen mask. She was admitted to intensive care unit due to the extensive involvement of lungs that was seen in chest CT. Remdesivir 100 mg, Dexamethasone 6 mg, Enoxaparin 60 mg were prescribed for her. During the second day of hospitalisation O2 saturation decreased progressively (60-70%) so the mother being intubated and put under mechanical ventilation. Because of repetitive late deceleration in CTG, emergency Caesarean section was done. The Apgar score of the neonate was 2/10 and 6/10, so resuscitation protocol was done immediately. She was admitted to the neonatal intensive treatment unit. The result of the newborn's COVID-19 test was negative. The mother was successfully extubated after 3 days and discharged 7 days after Caesarean section. Presently, the condition evaluation of the mother and her newborn is normal. This case shows that immunological and physiologic changes during pregnancy making them more susceptible to viral infections and timely treatment can be successful. In addition, combination therapy of Remdesivir and Dexamethasone can be a suitable treatment choice for pregnant women infected with COVID-19. In this respect, it is worth mentioning that more studies are required to evaluate the side effects of Remdesivir during pregnancy.

MATERNOFETAL OUTCOME IN MECONIUM STAINED LIQUOR AT TERTIARY CARE HOSPITAL

BACKGROUND: Occurance of meconium-stained amniotic uid (MSAF) during labour may be considered as a measure for prediction of poor fetal outcomes such as meconium aspiration syndrome and perinatal asphyxia ,resulting in perinatal as well as neonatal morbidity and mortality. It constitutes about 5% of deliveries with meconium stained amniotic uid and death results in about 12% of infants with MAS. METHODS: 40 cases of meconium stained liquor detected after spontaneous or artical rupture of membranes taken during labour from june 2020 to december 2020 and their outcome in terms of mode of delivery(whether vaginal delivery or lower segment caesarean section) and fetal outcome and associated maternal high risk were studied RESULT: Anemia was co existant in around 15%, pregnancy induced hypertension(PIH) in 25%and premature rupture of membrane in 10%.Pregnancies complicated with Pregnancy induced hypertension had signicant higher rate of meconium stained liquor among all cases. Caesarean Section was commonly performed in meconium stained amniotic uid cases and accounted for about 65%of all cases. CONCLUSIONS: Meconium Stained amniotic uid increases the chances of caesarean rates,leading to birth asphyxia ,Meconium Aspiration Syndrome and hence increases the chances of neonatal intensive unit admission.

Ethical concerns in Neonatal Intensive Unit: A Case Analysis

Neonatal nurses frequently encounter neonatal ethical issues related to provision of safe and quality care and communication in the NICU setup. This article discusses the hypothetical case of baby John diagnosed with neonatal sepsis. The ethical perspectives related to care and communication with the family members while their baby is receiving treatment in the NICU will be explored through the application of the QUAR framework.

Frequency of meconium stained liquor in low risk laboring women and its effect on perinatal outcome in a tertiary care hospital.

Objective: To evaluate the frequency of meconium stained liquor (MSL) in low risk women and its effect on perinatal outcomes. Study Design: Prospective Case Control study. Setting: Department of Obstetrics and Gynecology Military Hospital, Rawalpindi. Period: January to August 2017. Material & Methods: Distribution of MSL was studied according to its grade. Data included demographic profile, mode of delivery, intrapartum factors and neonatal outcomes. Descriptive statistics and chi-square were used for analysis. Results: Frequency of MSL was 376 (3.65%) among 10,281 deliveries during study period. A total of 752 women were included in the study which were divided into cases and controls. Nulliparity and advanced gestational age were significantly associated with MSL. Distribution of grade of meconium was 20.5%, 56.4% and 23.1% for grade I, II and III MSL. Breech presentation, fetal heart rate abnormalities and cesarean section were significantly associated with MSL. Low apgar score at 1 and 5 minutes, Neonatal intensive unit care admissions and fetal complications had positive correlation with MSL. Frequency of meconium aspiration syndrome (MAS) was 16.4%, birth asphyxia 5.31% and respiratory distress syndrome (RDS) 1.32% amongst all the cases of MSL. However, frequency of MAS, birth asphyxia and RDS was 0.6%, 0.19%, 0.02% in general obstetric population. Neonatal mortality was 29% in MAS, 3.4% in MSL and 0.12% in general population. Adverse neonatal outcomes had positive correlation with increasing grade of meconium. Conclusion: There is a significant frequency of meconium stained liquor even in low risk women. MSL is significantly associated with increased cesarean section rates and adverse neonatal outcomes.

Association between body composition at term equivalent age and Bayley scores at 2 years in preterm infants.

To evaluate whether in a historical cohort of preterm infants, body composition at term equivalent age (TEA) correlated with Bayley scores at 2 years of corrected age. Ninety-five preterm babies were admitted to our neonatal intensive unit and underwent air-displacement plethysmography assessment at TEA. Of these, 74 completed Bayley tests at 2 years. We used multiple linear regression analysis to assess the association of body composition with Bayley scores. Mean gestational age and birthweight of our population were respectively 29.8 (±2.2) weeks and 1150 (±330) grams. Higher fat-free mass (FFM) z-score was associated with higher language (adjusted r = 0.28, p = 0.03) and motor composite scores (adjusted r = 0.33, p = 0.03) in both univariate and multiple regression analysis including birth weight, sex, maternal university degree, mechanical ventilation, and bilingualism. In our study FFM at term equivalent age was associated with higher Bayley composite motor and language scores at 2 years.

UTI NEONATAL: o que dizem as mães

The present study has as objective to analize the percepcion of mothers of preterm babies with very low birth weight and extremely low birth weight under the process of hospitalization of their infants in a neonatal intensive therapy unit (NITU). Ten mothers of premature newborn infants hospitalized in a reference maternity in the execution of the Kangaroo Method, located in Florianópolis – SC participated of the research. The instruments used for the data gathering were the sociodemographic data record to trace the profile of the partcipants; and a semi structured interview script to explore some unfoldings about the experience of the hospitalization of their infants in the NITU, among them, the gestational and hospitalization process. The results suggests that these mothers experience an oscilation of feelings motivated by insecurity and fear, considering the clinical complications and the health situation of their infants. They also evidenced that the birth of a premature baby causes many modifications in the familiar life, specially of the mothers who takes on the role of accompany in the hospital unit, expressing the need of support, considering that sometimes, they leave their other infants under the care of another person and their further activities. Finally, it pointed out the importance of the care lined in the principles of humanization, meaning not only the care of preterm babies, but, of these mothers and families that find themselves fragilized due the lived experience, as well.

Terapêutica com surfactante em recém-nascidos prematuros: tendência para uma abordagem menos invasiva

Introduction: Minimally invasive surfactant therapy (MIST) is a surfactant administration procedure that intends to reduce intubations and associated risks. The aim of this study was to compare MIST with INtubation-SURfactant-Extubation (INSURE) technique. Material and methods: Retrospective analysis (from January 2015 to June 2019) of preterm infants on nasal continuous positive airway pressure (nCPAP) treated with surfactant. Results: Fifty-four preterm infants were included and divided in two groups: MIST (n=34) and INSURE (n=20). No significant differences were found between groups regarding gestational age (p=0.480), birth weight (p=0.299), fraction of inspired oxygen (FiO2) prior to surfactant (p=0.220), oxygen therapy duration (p=0.306), progression to intubation (p=0.712), or length of Neonatal Intensive Care Unit stay (p=0.778). FiO2 variation before and after surfactant administration was higher in MIST group (14% vs 9%, p=0.078). No significant complications were reported with either technique. Conclusions: MIST is a safe technique in preterm infants on nCPAP. This study shows similar outcomes with MIST and INSURE procedures, with a greater reduction in FiO2 requirements with MIST. Overall, MIST is less invasive and as effective as INSURE in preterm infants.

Failure of non-invasive continuous positive airway pressure as the initial respiratory support in very preterm infants: a multicenter prospective cohort study

Objective: To analyze the risk factors and the adverse outcomes of failure in non-invasive continuous positive airway pressure (CPAP) as the initial respiratory support in very preterm infants with gestational age at birth <32 weeks. Methods: This multicenter prospective cohort study was conducted from January 1, 2019 to December 31, 2019 based on the data from Shandong Neonatal Network (SNN). Perinatal information, clinical treatment, and the short-term outcomes of very preterm infants with gestational age at birth of 25-31+6 weeks in 30 neonatal intensive care units (NICU) in SNN were collected. The very preterm infants with non-invasive CPAP as the initial respiratory support were divided into the group of non-invasive CPAP failure and the group of non-invasive CPAP success. The difference in the risk factors between the two groups were tested by χ2 test or Fisher exact and the Mann-Whitney U test, followed by Logistic regression analysis for all the risk factors with statistically significant difference. Results: A total of 1 040 very preterm infants were included in this study, including 577 males (55.5%) and 463 females (44.5%). There were 195 cases (18.8%) with gestational age of 25-28+6 weeks, 845 cases (81.2%) with gestational age of 29-31+6 weeks, 81 cases (7.8%) with birth weight<1 000 g and 959 cases (92.2%) with birth weight≥1 000 g. Overall, the rate of CPAP success (n=902, 86.7%) was higher than that of CPAP failure (n=138, 13.3%). The incidence of CPAP failure was 24.6% (48/195) and 10.7% (90/845) respectively for infants with gestational age of 25-28+6 weeks and of 29-31+6 weeks. The Logistic regression analysis showed that smaller gestational age at birth, maternal gestational hypertension disease, and severe respiratory distress syndrome (RDS, grade Ⅲ-Ⅳ) requiring pulmonary surfactant (PS) for more than twice and fraction of inspired oxygen (FiO2)>0.30 after birth were independent risk factors for the failure of initially used non-invasive CPAP (OR=0.718, 1.847, 4.003, 6.712, 1.948; 95%CI:0.590-0.873, 1.130-3.018, 2.435-6.579, 3.160-14.259, 1.189-3.192; all P<0.05). The incidence of adverse outcomes in the group of failure was significantly higher than in the group of success, including death, neonatal pulmonary hemorrhage, moderate or severe broncho pulmonary dysplasia (BPD), and severe intraventricular hemorrhage (IVH) (OR=4.436, 26.393, 1.998, 4.545; 95%CI:2.106-9.344, 9.690-71.885, 1.031-3.875, 1.615-12.795; all P<0.05). Conclusions: The very preterm infants with gestational age at birth<32 weeks have a higher incidence of major adverse outcomes after the failure of initially used non-invasive CPAP. Smaller gestational age at birth, maternal gestational hypertension disease and severe RDS (grade Ⅲ-Ⅳ) requiring PS for more than twice and FiO2>0.30 after birth are independent risk factors for the failure of initially used non-invasive CPAP.