Outcomes and complications of invasive versus non-invasive respiratory support in extremely preterm infants: a retrospective study

BACKGROUND: Because the respiratory system of extremely/very preterm infants is immature, respiratory support is essential to their care; however, the effects of invasive and non-invasive ventilation modes on prognosis and complications remain controversial. The efficacy and safety of invasive mechanical ventilation (IMV), nasal continuous positive airway pressure (NCPAP), and non-invasive high-frequency oscillatory ventilation (NHFOV) were to be compared in extremely/very preterm infants. METHODS: Clinical data from 220 extremely/very preterm infants admitted between January 2024 and March 2025 were retrospectively analyzed. Infants were stratified by initial ventilation modality into the invasive group (AG, n = 87), the non-invasive NCPAP group (BG, n = 82), and the non-invasive NHFOV group (CG, n = 51); treatment outcomes and complications were compared. RESULTS: The CG had the shortest total ventilation time (8.5 ± 2.8 days), the lowest rate of reintubation (17.6%), and the highest weaning success rate (88.2%), all of which were superior to the other groups (P < 0.05); the AG had the highest incidence of bronchopulmonary dysplasia (37.9%) and intracranial hemorrhage (13.8%) (P < 0.05). Mortality, necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and sepsis incidence not statistically significant among the three groups (P > 0.05). CONCLUSION: Non-invasive ventilation, especially NHFOV, was found to optimize treatment outcomes and reduce complications in extremely/very preterm infants; its preferential use was recommended.