{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:10:53Z","timestamp":1771459853381,"version":"3.50.1"},"reference-count":27,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>This prospective observational study included infants with gestational ages between 230\/7 and 316\/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\u2009hours 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.<\/jats:p>\n                  <jats:p>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\u2013138.45; p\u2009&lt;\u20090.001), BPD (aOR: 2.61; 95% CI: 1.47\u20134.62; p\u2009&lt;\u20090.001), and mortality (aOR: 2.37; 95% CI: 1.32\u20134.23; p\u2009&lt;\u20090.001).<\/jats:p>\n                  <jats:p>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\u2009hours of life, is associated with adverse neonatal outcomes.<\/jats:p>","DOI":"10.1055\/a-2624-5642","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T18:54:48Z","timestamp":1750100088000},"page":"437-444","source":"Crossref","is-referenced-by-count":0,"title":["The Predictors and Outcomes of Early Noninvasive Positive Pressure Ventilation Failure in Very Preterm Infants: A Prospective Study"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0055-8277","authenticated-orcid":false,"given":"Mustafa Senol","family":"Akin","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Ankara Bilkent City Hospital, Ankara, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4643-7622","authenticated-orcid":false,"given":"Fatma Nur","family":"Sari","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0265-0229","authenticated-orcid":false,"given":"Aslihan Kose","family":"Cetinkaya","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Ankara Bilkent City Hospital, Ankara, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1990-6382","authenticated-orcid":false,"given":"Ismail Cagri","family":"Acikgoz","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Ankara Bilkent City Hospital, Ankara, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8956-0917","authenticated-orcid":false,"given":"Evrim Alyamac","family":"Dizdar","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"issue":"02","key":"ref1","first-page":"132","article-title":"Non-invasive ventilatory strategies to decrease bronchopulmonary dysplasia\u2014where are we in 2021?","volume":"8","author":"V Dumpa","year":"2021","journal-title":"Children (Basel)"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1016\/j.jpeds.2005.01.047","article-title":"Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes","volume":"146","author":"M C Walsh","year":"2005","journal-title":"J Pediatr"},{"issue":"10","key":"ref3","first-page":"CD002271","article-title":"Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants","volume":"10","author":"J J Ho","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"issue":"06","key":"ref4","first-page":"CD001243","article-title":"Prophylactic nasal continuous positive airway pressure for preventing morbidity and mortality in very preterm infants","volume":"6","author":"P Subramaniam","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1016\/S0140-6736(17)30312-4","article-title":"The evolution of modern respiratory care for preterm infants","volume":"389","author":"L S Owen","year":"2017","journal-title":"Lancet"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"e20153985","DOI":"10.1542\/peds.2015-3985","article-title":"Incidence and outcome of CPAP failure in preterm infants","volume":"138","author":"P A Dargaville","year":"2016","journal-title":"Pediatrics"},{"issue":"07","key":"ref7","first-page":"CD005384","article-title":"Early nasal intermittent positive pressure ventilation (NIPPV) versus early nasal continuous positive airway pressure (NCPAP) for preterm infants","volume":"7","author":"B Lemyre","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1111\/j.1651-2227.2011.02558.x","article-title":"Early prediction of nasal continuous positive airway pressure failure in preterm infants less than 30 weeks gestation","volume":"101","author":"A P De Jaegere","year":"2012","journal-title":"Acta Paediatr"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"F343","DOI":"10.1136\/adc.2010.205898","article-title":"Predictors of early nasal CPAP failure and effects of various intubation criteria on the rate of mechanical ventilation in preterm infants of <29 weeks gestational age","volume":"96","author":"H Fuchs","year":"2011","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1159\/000346460","article-title":"Continuous positive airway pressure failure in preterm infants: incidence, predictors and consequences","volume":"104","author":"P A Dargaville","year":"2013","journal-title":"Neonatology"},{"issue":"07","key":"ref11","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1056\/NEJMoa072788","article-title":"Nasal CPAP or intubation at birth for very preterm infants","volume":"358","author":"C J Morley","year":"2008","journal-title":"N Engl J Med"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"e1402","DOI":"10.1542\/peds.2009-2131","article-title":"Prophylactic or early selective surfactant combined with nCPAP in very preterm infants","volume":"125","author":"F Sandri","year":"2010","journal-title":"Pediatrics"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jpeds.2019.09.026","article-title":"Predictors and outcomes of early intubation in infants born at 28\u201336 weeks of gestation receiving noninvasive respiratory support","volume":"216","author":"C T Roberts","year":"2020","journal-title":"J Pediatr"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"680","DOI":"10.5114\/aoms.2019.83040","article-title":"Predictors of early synchronized non-invasive ventilation failure for infants < 32 weeks of gestational age with respiratory distress syndrome","volume":"15","author":"N M Handoka","year":"2019","journal-title":"Arch Med Sci"},{"key":"ref15","doi-asserted-by":"crossref","DOI":"10.1542\/9781610025256","volume-title":"Textbook of Neonatal Resuscitation","author":"G M Weiner","year":"2021"},{"issue":"S 01","key":"ref16","first-page":"S45","article-title":"Turkish Neonatal Society guideline on the management of respiratory distress syndrome and surfactant treatment","volume":"53","author":"H \u00d6zkan","year":"2018","journal-title":"Turk Pediatri Ars"},{"issue":"04","key":"ref17","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/S0022-3476(78)80282-0","article-title":"Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm","volume":"92","author":"L-A Papile","year":"1978","journal-title":"J Pediatr"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00000658-197801000-00001","article-title":"Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging","volume":"187","author":"M J Bell","year":"1978","journal-title":"Ann Surg"},{"issue":"07","key":"ref19","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1164\/ajrccm.163.7.2011060","article-title":"Bronchopulmonary dysplasia","volume":"163","author":"A H Jobe","year":"2001","journal-title":"Am J Respir Crit Care Med"},{"issue":"05","key":"ref20","doi-asserted-by":"crossref","first-page":"F359","DOI":"10.1136\/adc.2009.172957","article-title":"Pressure variation during ventilator generated nasal intermittent positive pressure ventilation in preterm infants","volume":"95","author":"L S Owen","year":"2010","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"08","key":"ref21","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1038\/s41372-019-0392-z","article-title":"Early predictors of continuous positive airway pressure failure in preterm neonates","volume":"39","author":"V Kakkilaya","year":"2019","journal-title":"J Perinatol"},{"issue":"05","key":"ref22","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.jpeds.2007.01.032","article-title":"Nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure for respiratory distress syndrome: a randomized, controlled, prospective study","volume":"150","author":"A Kugelman","year":"2007","journal-title":"J Pediatr"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jpeds.2013.08.040","article-title":"A randomized controlled trial of two nasal continuous positive airway pressure levels after extubation in preterm infants","volume":"164","author":"B Buzzella","year":"2014","journal-title":"J Pediatr"},{"issue":"12","key":"ref24","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/S2352-4642(23)00235-3","article-title":"Higher versus lower nasal continuous positive airway pressure for extubation of extremely preterm infants in Australia (\u00c9CLAT): a multicentre, randomised, superiority trial","volume":"7","author":"A M Kidman","year":"2023","journal-title":"Lancet Child Adolesc Health"},{"issue":"12","key":"ref25","doi-asserted-by":"crossref","first-page":"3879","DOI":"10.1002\/ppul.25678","article-title":"Early nasal continuous positive airway pressure failure prediction in preterm infants less than 32 weeks gestational age suffering from respiratory distress syndrome","volume":"56","author":"V Dell'Orto","year":"2021","journal-title":"Pediatr Pulmonol"},{"issue":"04","key":"ref26","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1038\/jp.2012.110","article-title":"Failure of early nasal continuous positive airway pressure in preterm infants of 26 to 30 weeks gestation","volume":"33","author":"G Rocha","year":"2013","journal-title":"J Perinatol"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1159\/000499674","article-title":"Fraction of inspired oxygen as a predictor of CPAP failure in preterm infants with respiratory distress syndrome: a prospective multicenter study","volume":"116","author":"E Gulczy\u0144ska","year":"2019","journal-title":"Neonatology"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2624-5642.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T23:40:53Z","timestamp":1771458053000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2624-5642"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,16]]},"references-count":27,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2026,2,18]]},"published-print":{"date-parts":[[2026,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2624-5642","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,16]]}}}