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Duration of and trends in respiratory support among extremely preterm infants
  1. Dany E Weisz1,2,
  2. Eugene Yoon3,
  3. Michael Dunn1,2,
  4. Julie Emberley4,
  5. Amit Mukerji5,
  6. Brooke Read6,
  7. Prakeshkumar S Shah2,3,7
  8. on behalf of the Canadian Neonatal Network Investigators
    1. 1 Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    2. 2 Paediatrics, University of Toronto, Toronto, Ontario, Canada
    3. 3 Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
    4. 4 Paediatrics, Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada
    5. 5 Paediatrics, McMaster University, Hamilton, Ontario, Canada
    6. 6 Paediatrics, London Health Sciences Centre Children's Hospital, London, Ontario, Canada
    7. 7 Mount Sinai Hospital, Toronto, Ontario, Canada
    1. Correspondence to Dr Dany E Weisz, Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; dany.weisz{at}


    Objective To evaluate annual trends in the administration and duration of respiratory support among preterm infants.

    Design Retrospective cohort study.

    Setting Tertiary neonatal intensive care units in the Canadian Neonatal Network.

    Patients 8881 extremely preterm infants born from 2010 to 2017 treated with endotracheal and/or non-invasive positive pressure support (PPS).

    Main outcome measures Competing risks methods were used to investigate the outcomes of mortality and time to first successful extubation, definitive extubation, weaning off PPS, and weaning PPS and/or low-flow oxygen, according to gestational age (GA). Cox proportional hazards and regression models were fitted to evaluate the trend in duration of respiratory support, survival and surfactant treatment over the study period.

    Results The percentages of infants who died or were weaned from respiratory support were presented graphically over time by GA. Advancing GA was associated with ordinally earlier weaning from respiratory support. Year over year, infants born at 23 weeks were initially and definitively weaned from endotracheal and all PPS earlier (HR 1.06, 95% CI 1.01 to 1.11, for all outcomes), while survival simultaneously increased (OR 1.11, 95% CI 1.03 to 1.18). Infants born at 26 and 27 weeks remained on non-invasive PPS longer (HR 0.97, 95% CI 0.95 to 0.98 and HR 0.97, 95% CI 0.95 to 0.99, respectively). Early surfactant treatment declined among infants born at 24–27 weeks GA.

    Conclusions Infants at the borderline of viability have experienced improved survival and earlier weaning from all forms of PPS, while those born at 26 and 27 weeks are spending more time on PPS in recent years. GA-based estimates of the duration of respiratory support and survival may assist in counselling, benchmarking, quality improvement and resource planning.

    • neonatology
    • epidemiology

    Statistics from


    • Twitter @danyweisz

    • Contributors DEW conceptualised and designed the study, interpreted the data, drafted the initial manuscript, and critically reviewed and revised the final manuscript. EY conceptualised and designed the study, analysed and interpreted the data, and critically reviewed and revised the final manuscript. BR and MD, JE, AM and PSS conceptualised and designed the study, interpreted the data, and critically reviewed and revised the final manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. PSS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of data analysis. EY conducted the data analysis.

    • Funding Organisational support for the Canadian Neonatal Network was provided by the Maternal-Infant Care (MiCare) Research Centre at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CIHR) (CTP 87518), by the Ontario Ministry of Health and Long-Term Care, and by the participating hospitals. PSS holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research from the CIHR (APR-126340).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the local research ethics board and CNN Executive Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. Data are from the Canadian Neonatal Network and comprise deidentified participant data.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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