Efficacy and Predictors of Noninvasive Ventilation in neonates with congenital heart disease

Background: To evaluate the outcomes of noninvasive ventilation (NIV) therapy in neonates with congenital heart disease at our institute, and identify predictors associated with noninvasive ventilation therapy. Methods: We examined 207 neonates who underwent cardiac surgery at a single institution from 2018 to 2023. Relevant data, such as demographic information, operative details, and postoperative records, were gathered from medical and surgical records. Our primary focus was on the NIV failure. Results: Median age and weight at surgery were 12(6-19) days and 3.3 (2.9-3.6) kg, respectively. 86(41.5%) patients were extubated to NIV (NIV group), and 121(58.5%) were not experienced NIV (No-NIV group). In NIV group, 47 (57.4%) were assigned to the preventive group and 39 (47.3%) to the non-preventive group. The NIV failure rate was 6.8% (14/86) and mortality rate was 2.4% (n=5). According to multivariate logistic regression analysis PaCO2>37.5mmHg at pre-extubation and requirement for emergent resuscitation before surgery were the independent predictors associated with NIV therapy, the duration of postoperative mechanical ventilation (MV), PaCO2 value at 24h post-extubation and vasoactive-inotropic score (VIS) influenced the occurrence of NIV failures, and there were more NIV failure happened after 24 hours of NIV therapy (8/14, 57.1%). For the patients with longer aortic cross‑clamp time, higher PCO2 value at pre-extubation and required peritoneal dialysis after surgery were more likely to receive preventive NIV therapy. Conclusions: NIV can be successfully used in neonates who after cardiac surgery. For patients at risk, the preventive NIV therapy could more effective in avoiding NIV failure.