Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Duration of noninvasive respiratory support in preterm infants: Association with gestational age and risk factors for delayed weaning

Journal of Perinatology volume 46, pages 50–54 (2026)Cite this article

Subjects

Abstract

Objective

To analyze the association between gestational age (GA) and postmenstrual age (PMA) at successful noninvasive respiratory support (NRS) —which includes noninvasive ventilation with neurally adjusted ventilatory assist (NIV-NAVA), nasal continuous positive airway pressure (nCPAP), and high-flow nasal cannula (HFNC)— weaning and to identify the risk factors affecting PMA at successful NRS weaning.

Study design

This retrospective cohort study included 449 preterm infants born before 32 weeks’ GA who were admitted to the neonatal intensive care unit between 2015 and 2023.

Results

The median PMA at successful weaning was 36.0 weeks. PMA at successful weaning was negatively correlated with GA. Only a small number of infants with earlier GA achieved successful weaning before 36 weeks of PMA. Earlier GA, small for GA, bubbly/cystic appearance on X-rays, and bowel perforation with ileostomy were identified as risk factors for delayed weaning.

Conclusion

Clinical interventions should consider these risks to optimize weaning outcomes.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Negative correlation between gestational age and postmenstrual age at successful noninvasive respiratory support.
Fig. 2: Successful noninvasive respiratory support weaning rate at postmenstrual ages.

Similar content being viewed by others

Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Crowley PA. Antenatal corticosteroid therapy: a meta-analysis of the randomized trials, 1972 to 1994. Am J Obstet Gynecol. 1995;173:322–35.

    Article  CAS  PubMed  Google Scholar 

  2. Speer CP, Sweet DG, Halliday HL. Surfactant therapy: past, present and future. Early Hum Dev. 2013;89:S22–4.

    Article  CAS  PubMed  Google Scholar 

  3. Marter LJV, Allred EN, Pagano M, Sanocka U, Parad R, Moore M, et al. Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease? The Neonatology Committee for the Developmental Network. Pediatrics. 2000;105:1194–201.

    Article  PubMed  Google Scholar 

  4. Rojas MA, Gonzalez A, Bancalari E, Claure N, Poole C, Silva-Neto G. Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease. J Pediatr. 1995;126:605–10.

    Article  CAS  PubMed  Google Scholar 

  5. Howlett A, Ohlsson A, Plakkal N. Inositol for respiratory distress syndrome in preterm infants. Cochrane Database Syst Rev. 2012;3:CD000366.

    Google Scholar 

  6. Kinsella JP, Greenough A, Abman SH. Bronchopulmonary dysplasia. Lancet. 2006;367:1421–31.

    Article  PubMed  Google Scholar 

  7. Walsh MC, Yao Q, Gettner P, Hale E, Collins M, Hensman A, et al. Impact of a physiologic definition on bronchopulmonary dysplasia rates. Pediatrics. 2004;114:1305–11.

    Article  PubMed  Google Scholar 

  8. Rastogi S, Rajasekhar H, Gupta A, Bhutada A, Rastogi D, Wung JT. Factors affecting the weaning from nasal CPAP in preterm neonates. Int J Pediatr. 2012;2012:416073.

    Article  PubMed  Google Scholar 

  9. Chen IL, Chen HL. Impact of Illness Severity and interventions on successful weaning from nasal CPAP in very preterm neonates: an observational study. Children. 2022;9:673.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Arai H, Ito M, Ito T, Ota S, Takahashi T. Bubbly and cystic appearance on chest radiograph of extremely preterm infants with bronchopulmonary dysplasia is associated with wheezing disorder. Acta Paediatr. 2020;109:711–9.

    Article  PubMed  Google Scholar 

  11. Ito M, Kato S, Saito M, Miyahashi N, Arai H, Namba F, et al. Bronchopulmonary dysplasia in extremely premature infants: a scoping review for identifying risk factors. Biomedicines. 2023;11:553.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48:452–8.

    Article  CAS  Google Scholar 

  13. Delft B, Ginderdeuren FV, Lefevere J, Delft C, Cools F. Weaning strategies for the withdrawal of non-invasive respiratory support applying continuous positive airway pressure in preterm infants: a systematic review and meta-analysis. BMJ Paediatr Open. 2020;4:e000858.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Talbot LJ, Sinyard RD, Rialon KL, Englum BR, Tracy ET, Rice HE. Influence of weight at enterostomy reversal on surgical outcomes in infants after emergent neonatal stoma creation. J Pediatr Surg. 2017;52:35–9.

    Article  PubMed  Google Scholar 

  15. Biniwale MA, Ehrenkranz RA. The role of nutrition in the prevention and management of bronchopulmonary dysplasia. Semin Perinatol. 2006;30:200–8.

    Article  PubMed  Google Scholar 

  16. Garcia-Anton A, Dreyfus L, Portefaix A, Baudin F, Plaisant F, Loppinet T, et al. Factors of late respiratory support or oxygen weaning in infants with bronchopulmonary dysplasia. Pediatr Pulmonol. 2025;60:e27367.

    Article  PubMed  Google Scholar 

  17. Wai KC, Keller RL, Lusk LA, Ballard RA, Chan DK. Characteristics of extremely low gestational age newborns undergoing tracheotomy: a secondary analysis of The Trial of Late Surfactant Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2017;143:13–9.

    Article  PubMed  Google Scholar 

  18. Ikeda K, Hasegawa H, Yamada Y, Mizogami M, Wasa M. Airway diseases in very low birth weight infants. J Perinatol. 2025;45:50–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan

    Shu Eguchi, Tomohiro Takeda & Atsushi Nakao

Authors
  1. Shu Eguchi
    View author publications

    Search author on:PubMed Google Scholar

  2. Tomohiro Takeda
    View author publications

    Search author on:PubMed Google Scholar

  3. Atsushi Nakao
    View author publications

    Search author on:PubMed Google Scholar

Contributions

SE and AN conceived and designed the study. SE performed material preparation, data collection, and the literature review. SE also analyzed and interpreted the results and drafted the manuscript. TT and AN supported the statistical analyses. AN supervised the study, including data analysis and interpretation. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Shu Eguchi.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of the Japanese Red Cross Medical Center (approval code: 1675) and conducted in accordance with the principles of the Declaration of Helsinki.

Consent for publication

Because this was a retrospective observational study, the requirement for written informed consent was waived, and the study proceeded using an opt-out approach.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Eguchi, S., Takeda, T. & Nakao, A. Duration of noninvasive respiratory support in preterm infants: Association with gestational age and risk factors for delayed weaning. J Perinatol 46, 50–54 (2026). https://doi.org/10.1038/s41372-025-02492-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41372-025-02492-x

Search

Advanced search

Quick links