ความสัมพันธ์ระหว่างเวลาเริ่มใช้เครื่องช่วยหายใจแรงดันบวกแบบต่อเนื่องกับผลลัพธ์ทางคลินิกในทารกแรกเกิดที่มีภาวะหายใจลำบาก

Naovarut Thipbunsup; Jarupan Khunphet

Authors

Naovarut Thipbunsup Lang Suan Hospital, Chumphon
Jarupan Khunphet Lang Suan Hospital, Chumphon

Keywords:

Continuous positive airway pressure, Neonates, Respiratory distress, CPAP failure, Timing of initiation

Abstract

Background: Respiratory distress is a major clinical problem in neonates, and continuous positive airway pressure (CPAP) is widely used as non-invasive respiratory support. However, evidence regarding the association between CPAP initiation timing and treatment failure remains limited.

Objective: To examine the association between CPAP initiation timing and CPAP failure, compare clinical parameters before and after CPAP initiation, and identify factors associated with CPAP failure.

Methods: This retrospective analytical cohort study included 120 neonates with respiratory distress who received CPAP at Lang Suan Hospital between 2020 and 2025. CPAP failure was defined as endotracheal intubation for respiratory causes within 72 hours of CPAP initiation. Data were analysed using descriptive statistics, paired t-tests, chi-square tests, and logistic regression.

Results: Of the neonates, 62.5% were preterm, with a mean gestational age of 34.2 ± 3.1 weeks. Within 30–60 minutes after CPAP initiation, respiratory rate and FiO₂ decreased, whereas SpO₂ increased significantly (p < .001). CPAP treatment was successful in 72.5% of cases and failed in 27.5%. Neonates receiving CPAP within one hour had an 85.0% success rate; however, the overall association between initiation-time categories and treatment outcome was not statistically significant (p = .072). Multivariable analysis showed that each one-week increase in gestational age was associated with lower odds of CPAP failure (aOR = 0.80; 95% CI 0.68–0.95; p = .011). RDS was associated with higher odds of failure (aOR = 3.10; 95% CI 1.05–9.15; p = .040), as was each 0.1 increase in initial FiO₂ (aOR = 1.88; 95% CI 1.02–3.46; p = .043). CPAP initiation time analysed continuously was not significantly associated with failure (aOR = 1.16; 95% CI 0.92–1.46; p = .209).

Conclusion: Gestational age, RDS diagnosis, and initial oxygen requirement were associated with CPAP failure, whereas CPAP initiation timing was not significantly associated with failure. Prospective studies are needed to confirm the potential benefit of earlier CPAP initiation.

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