Impact of prolonged mechanical ventilation in very low birth weight infants

초록

Introduction: Prolonged mechanical ventilation is associated with numerous complications including mortality. This study aimed to evaluate in-hospital consequences of prolonged invasive ventilatory support in very low birth weight (VLBW) infants. Methods: Using national data from the Korean Neonatal Network, we reviewed medical records of VLBW infants who survived at least 4 weeks (n=2921), born from January 2013 to December 2014. Results: The mortality was increased consistently according to the duration of invasive ventilatory support (r=0.947, P<0.001), up to 50% when the mechanical ventilation was continued over 3 months. The invasive ventilation duration was significantly correlated with the severity of bronchopulmonary dysplasia (BPD) (rho=0.715, P<0.001) and the cumulative survival rate was significantly decreased in infants with severe BPD (P<0.001). In logistic regression analysis, infants who required invasive ventilation more than 4 weeks were significantly prone to have severe retinopathy of prematurity (P=0.034; OR 1.66, 95% CI=1.04-2.65) and periventricular leukomalacia (P=0.047; OR 1.78, 95% CI=1.01-3.15). And under correction of gestational age and birth weight, the increased duration of mechanical ventilation was significantly correlated with extension of hospital stay and parenteral nutrition (r=0.603, P<0.001 and r=0.488, P<0.001, respectively). Conclusion: The duration of invasive mechanical ventilation was significantly associated with higher mortality and various morbidities in VLBW infants in Korea. Aggressive weaning strategies of ventilator are required to improve the survival and other outcomes of these vulnerable infants.