Bronchopulmonary dysplasia in preterm infants managed with non-invasive ventilation or surfactant and a brief period of mechanical ventilation: a 6-year cohort study.

OBJECTIVE: Non-invasive ventilation (NIV) is increasingly used as first-line management of respiratory distress syndrome in preterm infants to avoid the lung-damaging effects of mechanical ventilation (MV). We hypothesised that even a short period of MV following surfactant treatment would increase the rate of bronchopulmonary dysplasia (BPD).
METHODS: Retrospective study including preterm infants <30 weeks gestational age over a six-year period if they required surfactant followed by MV not longer than 24 h (SURF&MV group) or if managed exclusively with NIV (NIV group). Baseline and morbidity variables such as gestation, birth weight, sex, place of birth, antenatal steroids, sepsis, pneumothorax, intraventricular haemorrhage, necrotising enterocolitis, and patent ductus arteriosus were analysed in a multivariate model for potential confounding.
RESULTS: 289 infants were included: 150 in the NIV group and 139 in the SURF&MV group. Seventeen infants in the NIV group and 23 in the SURF&MV group developed BPD (odds ratio: 1.55; 95% confidence interval (CI): 0.79-3.05; p = 0.202). After adjusting for potential confounders, the odds ratio was 1.09 for the SURF&MV group to develop BPD (95% CI: 0.52-2.28; p = 0.812).
CONCLUSION: The rate of BPD did not differ between infants managed with NIV or with surfactant administration followed by ≤24 h of MV after adjusting for confounding factors.