Association between mechanical ventilation duration and maternal–neonatal factors in critically ill neonates: A retrospective study

Abstract

Objective:

To examine the associations between neonatal–maternal characteristics and mechanical ventilation duration in critically ill neonates, and to explore differences between respiratory distress syndrome (RDS) and non-RDS subgroups.

Methods:

This retrospective study included 319 neonates who required mechanical ventilation in the neonatal intensive care unit of our hospital between 1 January 2022 and 31 December 2024. Data on neonatal demographics, Apgar scores, initial arterial blood gas parameters and maternal characteristics, including age, delivery mode and comorbidities, were collected. The primary outcome was total ventilation duration. Correlation and subgroup analyses were performed.

Results:

The median duration of total mechanical ventilation (invasive + non-invasive) was 133.0 (interquartile range (IQR): 146.0) h. All neonates received invasive mechanical ventilation with a median duration of 48.0 (IQR: 58.0) h, and 83.7% subsequently required non-invasive ventilation support. Ventilation duration was negatively correlated with gestational age (r = −0.503, p < 0.001) and birth weight (r = −0.473, p < 0.001) and positively correlated with blood pH (r = 0.142, p = 0.011), using PS (r = 0.439, p < 0.001) and bicarbonate (r = 0.141, p = 0.012). No significant associations were found with Apgar scores, lactate or maternal age. Compared with non-RDS neonates, those with RDS had significantly longer ventilation durations (135.0 (IQR: 147.0) vs 73.5 (IQR: 100.8) h, p < 0.001), as well as lower gestational age and birth weight, altered blood gas parameters and a higher rate of caesarean deliveries (all p < 0.05). Maternal comorbidity rates did not differ significantly between the groups (p > 0.05). The results of multivariate regression analysis showed that the independent factors affecting mechanical ventilation time were gestational age, pulmonary surfactant, birth weight, blood pH, HCO₃⁻ and mode of delivery.

Conclusions:

Neonatal factors, especially gestational age and birth weight, critically impact ventilation duration in critically ill neonates. Tailored respiratory management addressing diagnosis and key perinatal factors (gestational age, birth weight) may improve outcomes.