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The following is a summary of “Non-invasive Respiratory Support or Intubation during Stabilization after Birth and Neonatal and Neurodevelopmental Outcomes in Infants Born Preterm at 23-25 Weeks of Gestation,” published in the August 2024 issue of Pediatrics by Lipp et al.

This study investigates the impact of non-invasive respiratory support (NRS) compared to tracheal intubation (TI) during the initial stabilization period on severe brain injury (sBI), death, and significant neurodevelopmental impairment (sNDI) in infants born at 23 to 25 weeks of gestation. As a retrospective cohort study across Canada, the research included infants managed with either NRS or TI within the first 30 minutes after birth. The primary outcomes assessed were sBI or death before discharge and sNDI among survivors with follow-up at 18 to 24 months of corrected age. Logistic regression models and propensity score matched (PSM) analyses were utilized to evaluate associations between the type of respiratory support and the outcomes.

The cohort comprised infants with a mean gestational age of 24.6 weeks and a birth weight of 757 grams in the NRS group, compared to 24.3 weeks and 705 grams in the TI group (p < 0.01 for both metrics). Notably, 77% of infants in the NRS group required intubation by seven days of age. Severe brain injury or death occurred in 25% of infants in the NRS group and 36% in the TI group, yielding an adjusted odds ratio (aOR) of 0.74 (95% [CI] 0.60, 0.91) favoring NRS. Among survivors with follow-up data, sNDI was observed in 17% of the NRS group compared to 23% of the TI group, with an aOR of 0.77 (95% CI 0.60, 0.99). PSM analyses confirmed a reduced risk of sBI or death associated with NRS (odds ratio [OR] 0.72, 95% CI 0.60, 0.86), though no significant difference was found for sNDI outcomes (OR 0.78, 95% CI 0.58, 1.05).

In conclusion, infants born at 23-25 weeks of gestation who received NRS rather than TI during the initial stabilization period had a lower likelihood of severe brain injury or death before discharge. However, no significant difference in neurodevelopmental outcomes among survivors was observed between the two groups.

Source: sciencedirect.com/science/article/pii/S0022347624003731