Rising rates of non-invasive ventilation and bronchopulmonary dysplasia: A propensity score-matched analysis.

BACKGROUND

Given the multiple risk factors associated with bronchopulmonary dysplasia, the impact of advances in early respiratory management, particularly non-invasive ventilation, remains uncertain.

METHODS

The early respiratory management and outcomes in 593 infants born at less than 32 weeks' gestational age were retrospectively analyzed. The combined rate of bronchopulmonary dysplasia-mortality was compared across four propensity score-matched periods (2007-2010, 2011-2014, 2015-2018, 2019-2022).

RESULTS

Delivery room intubation rate decreased from 54% to 36.7% (P < 0.001). Surfactant administration was delayed in the first three periods from 0.33 to 1.5 h (P < 0.001). The composite outcome of death or bronchopulmonary dysplasia rose from 14.9% to 39.8% over time, while mortality alone remained stable. In parallel, non-invasive ventilation duration increased with an adjusted mean difference of 21.98 days in 2019-2022.

CONCLUSION

The incidence of bronchopulmonary dysplasia continues to rise for very preterm infants, despite changes in early respiratory management and the increased use of non-invasive ventilation.