Factors associated with SiPAP failure in late preterm infants with respiratory insufficiency

Introduction
: SiPAP is a popular method of non-invasive respiratory support in Polish NICUs. Risk factors associated with treatment failure in late preterm infants are poorly understood. Aim of the study was to delineate risk factors of treatment failure when SiPAP is used as a primary modality of respiratory support following delivery.

Material and methods
This is a retrospective study that included 184 neonates born between 2009 and 2014 with a mean gestational age (GA) of 34 3/7 weeks, and mean birth weight of 2200 grams. The parameters of ventilation during the use of SIPAP method, neonatal status and complications were compared between the failure and the success group. Success was defined as possibility of discharging from SiPAP. Failure of SiPAP method was defined as necessity for intubation with applying invasive mechanical ventilation or occurrence of pneumothorax. Logistic regression models were used to determine which factors had a significant impact on SiPAP failure.

Results
Treatment failure was noted in 28.8% of infants. Pneumothorax was found in 4.9% of newborns treated with SiPAP. There were no significant differences in GA, birth weight, Apgar score between the groups. In the failure group, the newborns were significantly later connected to the SiPAP device; they also had significantly higher Silverman score. Congenital pneumonia (OR = 2.45), respiratory distress syndrome (RDS) grade II (OR = 5.97), intracranial hemorrhage (IVH) grade II-IV (OR = 3.29), necessity to use sedation drugs (OR = 6.05) and increase of FiO2 as well as breath rates with SiPAP (OR = 2.85; OR = 16.0) are in relation to the failure of the SIPAP.

Conclusions
Factors associated with SiPAP failure among late preterm infants were a delay in initiation of SiPAP, severity of RDS, high oxygen requirements, and presence of grade II IVH.