Objective To investigate the association between invasive mechanical ventilation (IMV) duration and long-term neurodevelopmental outcomes in preterm infants in an era of restricted IMV.
Design Retrospective cohort study.
Setting Single neonatal intensive care unit in Amsterdam.
Patients All ventilated patients with a gestational age between 24 and 30 weeks born between 2010 and 2015.
Main outcome measures Neurodevelopmental impairment (NDI) at 24 months corrected age (CA). Data on patient characteristics, respiratory management, neonatal morbidities, mortality and bronchopulmonary dysplasia were collected. The relationship between IMV duration and NDI was determined by multivariate logistic regression analysis.
Results During the study period, 368 admitted infants received IMV for a median duration of 2 days. Moderate and severe bronchopulmonary dysplasia was diagnosed in 33% of the infant. Multivariate regression analysis with adjustment for gestational age, small for gestational age and socioeconomic status showed a significant association between every day of IMV and NDI at 24 months CA (adjusted OR [aOR] 1.08, 95% CI 1.004 to 1.16, p=0.04). This association only reached borderline significance when also adjusting for severe neonatal morbidity (aOR 1.08, 95% CI 1.00 to 1.17, p=0.05).
Conclusion Even in an era of restricted IMV, every additional day of IMV in preterm infants is strongly associated with an increased risk of NDI at 24 months CA. Limiting IMV should be an important focus in the treatment of preterm infants.
- mechanical ventilation
- bronchopulmonary dysplasia
- neurodevelopmental outcome
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Contributors Conception and study design: RJSV, AHvanK, WO. Collection, analysis and interpretation of data: RJSV, AHvanK, CSHA-M, AGvanW, WO. Drafting the manuscript for important intellectual content: RJSV, AHvanK, WO. Decision to submit the paper for publication: RJSV, AHvanK, CSHA-M, AGvanW, WO. RJSV wrote the first draft of the manuscript. No payment was given to anyone to produce the manuscript. All authors approved the final version to be published. RJSV will act as corresponding author for this paper.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Ethics approval The institutional review board approved this study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All available data are presented in the included manuscript. Therefore, no data sharing statement is neccessary.
Patient consent for publication Not required.
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