Clinical and perinatal factors associated with the need for invasive mechanical ventilation in newborns hospitalized in a neonatal intensive care unit in Ecuador: A retrospective study

Abstract

Various international studies have identified neonatal risk factors associated with the need for invasive mechanical ventilation. In Ecuador, a large percentage of neonatal intensive care units face limitations in infrastructure, availability of supplies, equipment, specialized human talent, and standardized protocols. Therefore, it is fundamental to provide local evidence on factors associated with the need for invasive mechanical ventilation (IMV) in an Ecuadorian neonatal unit, identifying vulnerable neonates to anticipate the need for respiratory support in a timely manner. Objective: It has been documented that prematurity, low birth weight, low Apgar scores, and neonatal sepsis are associated with a higher requirement for mechanical ventilation. This study aims to specifically analyze these factors to contribute to the early identification of neonates at higher respiratory risk, optimize the use of resources, improve the quality of care, and reduce morbidity and mortality. Methods: This study is an observational, analytical, and retrospective single-center cohort study, based on the analysis of a fully anonymized database, with the primary outcome being the need for invasive mechanical ventilation during neonatal hospitalization. Results: The results show that hyaline membrane disease and neonatal sepsis are the main clinical factors associated with the requirement for invasive mechanical ventilation in hospitalized newborns. Lower gestational age and the 1-minute Apgar score behaved as early markers of the need for invasive intervention. Conclusions: The clinical implications of this work point towards the implementation of preventive strategies such as the timely administration of antenatal corticosteroids for lung maturation, monitoring of neonatal sepsis, and optimization of early respiratory support, especially in premature patients.