This study aimed to investigate the clinical efficacy and safety of different non-invasive respiratory support methods in preterm infants with respiratory distress syndrome (RDS) after extubation. Methods: From Oct 2017 to 2018, 120 preterm infants were recruited from the NICUs of three hospitals. They were diagnosed with RDS and required mechanical ventilation. After extubation from mechanical ventilation, these infants were divided into NCPAP group, SNIPPV group and SNIPPV + NCPAP group. The time of non-invasive ventilation, reintubation rate within 72 h, success rate of non-invasive ventilation within 1 week, duration of oxygen therapy, hospital stay and incidence of complications were recorded and compared. Results: Compared with the NCPAP group, the SNIPPV group and the SNIPPV + NCPAP group had significantly higher rate of successful extubation and removal from non-invasive ventilation within 1 week (P < 0.05). There were no significant differences among three groups in the time of non-invasive ventilation, time of oxygen therapy, hospital stay or incidence of complications (P > 0.05). Conclusion: SNIPPV + NCPAP after mechanical ventilation is a relatively safe and effective ventilation strategy for preterm infants with severe RDS. The use of NCPAP facilitates the turnover of SNIPPV ventilators in developing countries.

Objectives: This study aimed to identify variables and develop a prediction model that could estimate extubation failure (EF) in preterm infants.Study Design: We enrolled 128 neonates as a training cohort and 58 neonates as a validation cohort. They were born between 2015 and 2020, had a gestational age between 250/7 and 296/7 weeks, and had been treated with mechanical ventilation through endotracheal intubation (MVEI) because of acute respiratory distress syndrome. In the training cohort, we performed univariate logistic regression analysis along with stepwise discriminant analysis to identify EF predictors. A monogram based on five predictors was built. The concordance index and calibration plot were used to assess the efficiency of the nomogram in the training and validation cohorts.Results: The results of this study identified a 5-min Apgar score, early-onset sepsis, hemoglobin before extubation, pH before extubation, and caffeine administration as independent risk factors that could be combined for accurate prediction of EF. The EF nomogram was created using these five predictors. The area under the receiver operator characteristic curve was 0.824 (95% confidence interval 0.748–0.900). The concordance index in the training and validation cohorts was 0.824 and 0.797, respectively. The calibration plots showed high coherence between the predicted probability of EF and actual observation.Conclusions: This EF nomogram was a useful model for the precise prediction of EF risk in preterm infants who were between 250/7 and 296/7 weeks' gestational age and treated with MVEI because of acute respiratory distress syndrome.

Purpose : To investigate the effects of trajectory of hemoglobin and duration of anemia over the first 5 weeks of life on risk of retinopathy of prematurity (ROP).Methods: We enrolled 465 premature infants with <32 gestational weeks or <1500g. Logistic regression was performed to analyze associations between the risk of ROP and hemoglobin, anemia and the number of blood transfusions at each gestational week. Generalized estimating equation was used to analyze the association of ROP with repeated-measured hemoglobin, anemia and blood transfusions. Finally, the dose-response relationship between hemoglobin level during the first week and the risks of ROP were analyzed using restrictive cubic spline analysis.Results: ROP was associated with decreased hemoglobin concentrations [OR = 0.997, 95%CIs = 0.994～1.000), anemia (OR = 1.175, 95%CIs = 1.011～1.364) and increased numbers of blood transfusion (OR = 1.373, 95%CIs = 1.233～1.528). Compared to the high trajectory of hemoglobin, infants with low hemoglobin trajectory had high risk of ROP (OR = 1.553, 95%CIs = 1.040～2.320). The hemoglobin during the postnatal first week was associated with risk of ROP in a nonlinear manner. The risk of ROP was lowest when the concentration of hemoglobin was approximate 140g/L.Conclusions: Anemia and blood transfusion after birth were independent risk factors of ROP. Besides, the concentrations of hemoglobin during the first five weeks of life was associated with the risk of ROP, and should be controlled at 140g/L in premature neonates immediately.