The Predictors and Outcomes of Early Noninvasive Positive Pressure Ventilation Failure in Very Preterm Infants: A Prospective Study

Limited data exist on predicting nasal intermittent positive pressure ventilation (NIPPV) failure in very preterm infants. This study aimed to identify factors predicting NIPPV failure, focusing on the fraction of inspired oxygen (FiO₂), and evaluating associated outcomes.This prospective observational study included infants with gestational ages between 23^0/7 and 31^6/7 weeks, who were managed with NIPPV as the initial respiratory support. Infants were categorized as either successfully managed with NIPPV (NIPPV-S) or failed and required intubation within the first 72 hours of life (NIPPV-F). Predictors of NIPPV failure and clinical outcomes were evaluated. ROC curve analysis was used to determine FiO₂ thresholds in the first and second hours of life. Demographic, perinatal, and respiratory parameters were analyzed using univariate and multivariate logistic regression models.Of the 397 infants, 121 (30.5%) failed NIPPV and required intubation. Multivariate analysis revealed that FiO₂ in the first hour, FiO₂ in the second hour, and mean airway pressure were independent predictors of NIPPV failure. The optimal FiO₂ threshold was 0.32 (sensitivity, 79% and specificity, 50%) for the first hour and 0.31 (sensitivity, 75% and specificity, 55%) for the second hour of life. NIPPV failure was associated with an increased risk of pneumothorax (adjusted odds ratio [aOR]: 16.83; 95% confidence interval [CI]: 2.05-138.45; <i>p</i> < 0.001), BPD (aOR: 2.61; 95% CI: 1.47-4.62; <i>p</i> < 0.001), and mortality (aOR: 2.37; 95% CI: 1.32-4.23; <i>p</i> < 0.001).FiO₂ is a valuable predictor of NIPPV success in the early hours of life. NIPPV failure, predicted by a FiO₂ exceeding 0.30 within the first 2 hours of life, is associated with adverse neonatal outcomes. · FiO2 > 0.30 in first 2 hours predicts NIPPV failure in very preterm infants.. · Early NIPPV failure is linked to increased risks of BPD, pneumothorax, and death.. · FiO2 and MAP are independent predictors of NIPPV failure..