51 - Non-invasive Respiratory Support During Stabilization at Birth and Neurodevelopmental outcomes in Preterm Infants 23-25 Weeks’ Gestation

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 51
Publication Number: 51.446

Rachel E. Lipp, University of Calgary, Calgary, AB, Canada; Amina A. Benlamri, University of Calgary, Calgary, AB, Canada; Abhay K. Lodha, University of Calgary, Calgary, AB, Canada; Julie McKanna, Alberta Health Services, Calgary, AB, Canada; Dany Weisz, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; M. Florencia Ricci, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Matt Hicks, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Marc Beltempo, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Amit Mukerji, McMaster University Michael G. DeGroote School of Medicine, Hamilton, ON, Canada; Ruben Alvaro, University of Manitoba, Winnipeg, MB, Canada; Eugene Ng, University of Toronto, Toronto, ON, Canada; Thuy Mai Luu, Centre Hospitalier Universitaire Sainte-Justine, Montreal, PQ, Canada; Prakesh S. Shah, Mount Sinai Hospital, Toronto, ON, Canada; Ayman Abou Mehrem, University of Calgary, Calgary, AB, Canada

Presenting Author(s)

Rachel E. Lipp, BScN, MD (she/her/hers)

General Pediatrics Resident Physician
University of Calgary
Calgary, Alberta, Canada

Background: The optimal respiratory management at birth of infants 23-25 weeks gestational age (GA) is controversial. It is unknown if successful non-invasive respiratory support (NRS), compared to intubation (ETT) during stabilization at birth is associated with neurodevelopmental outcomes in early childhood.

Objective: To study the association of successful NRS compared to ETT during stabilization in the first 30 minutes of birth, and neurodevelopmental impairment among infants of 23-25 weeks GA.

Design/Methods: Retrospective cohort study of infants 23^0/7-25^6/7 weeks GA, admitted to Canadian tertiary neonatal intensive care units (NICUs) in 2010-2019 that survived NICU discharge and had follow-up data. We excluded infants with major congenital anomalies, chromosomal abnormalities, moribund at birth, outborn infants, infants requiring chest compressions ≥30 seconds or received epinephrine, infants with APGAR scores ≤1 at 1 or 5 minutes.

Primary outcome was significant neurodevelopmental impairment (sNDI) at 18-30 months corrected age, defined as ≥1 of: Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) score < 70 in any domain, cerebral palsy with Gross Motor Function Classification Scale (GMFCS) ≥3, bilateral blindness, or deafness requiring amplification at 18-30 months. Groups were compared using descriptive statistics and three models of logistic regression to account for significant covariates. A propensity score matching analysis was also conducted.

Results: Of 1586 eligible infants, 1025 were in ETT group, and 561 in NRS group. Baseline characteristics and NICU management and outcomes are shown in Tables 1 and 2. The ETT group had higher crude rates of sNDI (23.8% vs. 18.7%, p = 0.02). Other NDI outcomes were not statistically significantly different. There was no significant difference in sNDI between groups (Model 1: aOR (adjusted odds ratio) 0.82 [0.63, 1.07], Model 2: aOR 0.79 [0.59, 1.06], Model 3: aOR 0.82 [0.64, 1.06]); however, point estimates were in favour of NRS group. Similar results were identified in 555 propensity score matched comparison; aOR 0.85, 95% CI 0.68, 1.05 (Table 3).

Conclusion(s): In this retrospective cohort, stabilization using NRS in the first 30 minutes after birth compared to ETT, was not associated with neurodevelopmental impairment at 18-30 months in 23-25 weeks’ gestation neonates.