High Altitude and Duration of Respiratory Support in Preterm Infants: A Multicenter, Observational Cohort from Latin America

Objective: Respiratory support use in neonatal intensive care units (NICUs) varies worldwide, influenced by clinical practices, resources, and patient populations. Whether high-altitude independently affects the duration of respiratory support in preterm infants remains unclear. This study aimed to determine whether altitude is independently associated with the duration of respiratory support in preterm infants ≤32 weeks' gestational age (GA) admitted to Latin American NICUs. Study Design: We performed a multicenter, observational cohort study by secondary analysis of prospectively collected data from the EpicLatino Network, a registry of NICUs across Latin America (2015-2022). Infants ≤32 weeks who received invasive or non-invasive respiratory support were included; supplemental oxygen delivered via low-flow nasal cannula or oxygen hood was not considered respiratory support, and those with missing outcome data were excluded. The primary outcome was total duration of respiratory support, measured as total days of support until discontinuation, discharge, transfer, or truncation by death. Altitude was classified as high (≥2,000 m) or low (