Sirichan Larpnarongchai, Gunlawadee Maneenil, Anucha Thatrimontrichai Supaporn Dissaneevate, Manapat Praditaukrit, Pattima Pakhathirathien
Prince of Songkla University.
Thailand
Journal of Clinical Medicine
J Clin Med 2026; 15:
DOI: 10.3390/jcm15114377
Abstract
Background/Objectives: Ventilator-free days (VFDs) are a useful composite measure to assess both survival and duration of mechanical ventilation in critically ill patients. This study aimed to determine the factors associated with (VFDs) in neonates with persistent pulmonary hypertension of the newborn (PPHN) and to compare VFDs according to the etiology and severity of PPHN.
Methods: We conducted a retrospective cohort study of neonates diagnosed with PPHN between 2013 and 2023. VFDs were defined as days alive and free of mechanical ventilation within the first 28 days. Severe-to-critical PPHN group was defined as an oxygenation index (OI) > 25.
Results: Among 175 neonates, the median (interquartile range [IQR]) VFDs were 20 (9-23) days. The factors independently associated with fewer VFDs included maximum OI > 40 (adjusted hazard ratio [aHR] 3.5, 95% confidence interval [CI]: 2.49-4.9), receiving more than two inotropic drugs (aHR 2.27, 95% CI: 1.49-3.45), acute kidney injury (AKI) (aHR 1.54, 95% CI: 1.1-2.17), and ventilator-associated pneumonia (VAP) (aHR 3.42, 95% CI: 1.8-6.48). The median (IQR) number of VFDs in neonates with PPHN secondary to respiratory distress syndrome (RDS), pneumonia/sepsis, meconium aspiration syndrome, and transient tachypnea of the newborn were 16 (0-22), 17 (7-21), 22 (11-24), and 22 (15-24) d, respectively (p = 0.023). Neonates in the severe-to-critical group had markedly fewer VFDs than those in the mild-to-moderate group (8.5 vs. 22 d, p < 0.001).
Conclusions: Infants with PPHN from RDS had the fewest VFDs. A maximum OI > 40, use of multiple inotropic agents, AKI, and VAP were associated with a low number of VFDs. Given the retrospective, single-center design, these findings are associative and hypothesis-generating, requiring prospective multi-center validation. Nonetheless, VFDs remain a comprehensive measure of both mortality and respiratory morbidity in this population.
Category
Class I. Persistent Pulmonary Hypertension of the Newborn
Symptoms and Findings Associated with Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes