Impact of prolonged invasive mechanical ventilation in extremely preterm infants on long-term neurodevelopmental and neurosensory outcomes: A narrative review.

Extremely preterm infants born before 28 weeks' gestation frequently require invasive mechanical ventilation because of profound respiratory immaturity. While advances in perinatal and neonatal care have substantially improved survival, prolonged exposure to invasive ventilation has emerged as an important contributor to long-term morbidity. This narrative review synthesizes current evidence on the association between prolonged invasive mechanical ventilation and long-term neurodevelopmental and neurosensory outcomes in extremely preterm infants, spanning infancy through adolescence and adulthood. Available observational and cohort studies consistently demonstrate that extended durations of invasive ventilation are associated with increased risks of adverse neurodevelopmental and neurosensory outcomes, including cognitive impairment, motor delay, cerebral palsy, visual impairment, and hearing loss, with evidence of a dose-response relationship whereby each additional day of ventilation increases the likelihood of impairment. These associations persist after adjustment for gestational age and major neonatal morbidities, suggesting that prolonged invasive ventilation acts both as a marker of illness severity and as a potential independent contributor to brain injury. Proposed biological mechanisms include ventilator-induced lung injury with systemic and cerebral inflammation, hemodynamic instability, fluctuations in oxygen and carbon dioxide levels, and cumulative exposure to corticosteroids, sedative and analgesic medications during critical periods of brain development. Although causality cannot be definitively established due to methodological heterogeneity, the consistency of findings underscores the importance of minimizing invasive ventilation whenever clinically feasible. Strategies emphasizing early noninvasive respiratory support, lung-protective ventilation, and structured weaning protocols are central to optimizing long-term neurodevelopmental and neurosensory outcomes in this vulnerable population.