Mode
Text Size
Log in / Sign up

Respiratory trajectories vary by gestational age in infants born before 26 weeks' gestationNew data tracks breathing progress for very premature infants

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway
Note that respiratory support requirements and extubation timelines vary significantly based on specific gestational age at birth.

This post-hoc exploratory analysis of a randomized controlled trial included 601 infants born before 26 weeks' gestation who received surfactant during initial neonatal intensive care admission. The study analyzed respiratory trajectories, including oxygen requirements and mechanical ventilation duration, across different gestational age cohorts.

Results showed significant variation based on birth age. For example, the median postnatal age at first extubation was 15 days (IQR 8-26) for infants born at 22-23 weeks, compared to 6 days (2-18) for those at 24 weeks and 3 days (1-10) for those at 25 weeks. The requirement for reintubation was 66% (54/82) in the 22-23 week group, 51% (80/158) in the 24 week group, and 38% (72/189) in the 25 week group.

At 40 weeks' postmenstrual age, the proportion of infants requiring oxygen or respiratory support was 85% (63/74) for those born at 22-23 weeks, 78% (97/124) for those born at 24 weeks, and 55% (79/143) for those born at 25 weeks. The median duration of mechanical ventilation was 36 days (IQR 23-49) for the 22-23 week group, 26 days (14-39) for the 24 week group, and 12 days (3-27) for the 25 week group.

As a post-hoc exploratory analysis, these results should be interpreted with caution. The data provide descriptive insights into respiratory trajectories but do not establish causal links between specific interventions and outcomes.

How this fits prior evidence

How this fits prior evidence: This study addresses a gap in understanding the progression of respiratory needs following surfactant treatment in very preterm infants. While previous coverage noted that multimodal lung-protective strategies reduce BPD risk, these findings provide more granular data on how gestational age specifically influences the timeline and intensity of respiratory support requirements for infants born before 26 weeks' gestation.

When a baby is born very prematurely, their lungs are often not ready to breathe on their own. Doctors use a substance called surfactant to help them breathe, but the journey toward getting off life support can be long and uncertain for families. This study looks at how these tiny patients progress over several months.

The researchers analyzed data from 601 infants born before 26 weeks of pregnancy across four countries. They tracked how much breathing support these babies needed during their first 14 days in the hospital and followed them until they were about 40 weeks old. The goal was to map out the typical path of respiratory care for different ages at birth.

Because this was an exploratory analysis of existing trial data, it provides a roadmap rather than a new treatment. It shows that babies born earlier often require more time on machines and more oxygen. For example, infants born at 25 weeks were much more likely to go home without needing extra oxygen compared to those born at 22-23 weeks. These findings help doctors give families clearer expectations during difficult times.

What this means for you:
Tracking breathing patterns helps doctors provide better information and care for babies born very early.

Common questions

How does breathing support change based on when a baby is born?

The amount of support depends heavily on gestational age. For example, infants born at 25 weeks were more likely to be discharged home without needing extra oxygen (55%) compared to those born at 22-23 weeks, who required oxygen or support in 85% of cases.

How long do babies typically stay on a breathing machine?

The time spent on mechanical ventilation varies by age. Infants born at 22-23 weeks stayed on machines for a median of 36 days, while those born at 24 weeks stayed for about 26 days, and those born at 25 weeks stayed for a median of 12 days.

What are the chances of going home without extra oxygen?

The likelihood of going home without supplemental oxygen at 40 weeks postmenstrual age increased with gestational age. It was 11% for infants born at 22-23 weeks, 23% for those at 24 weeks, and 30% for those born at 25 weeks.

Study Details

Study typeRct
EvidenceLevel 2
Follow-up6.0 mo
PublishedAug 2026
View Original Abstract ↓
BACKGROUND: To survive, infants born before 26 weeks' gestation require respiratory assistance immediately after birth. However, the respiratory trajectories of these most preterm infants are not well delineated. We aimed to describe the early respiratory trajectories of infants born before 26 weeks' gestation who received surfactant during their initial neonatal intensive care admission. METHODS: This study was a post-hoc exploratory analysis of PLUSS, a randomised controlled trial comparing intratracheal budesonide mixed with surfactant versus surfactant alone. Infants were recruited from 21 neonatal intensive care units in Australia, New Zealand, Canada, and Singapore. Infants born before 28 weeks' gestation and aged less than 48 h were eligible if (1) they were mechanically ventilated, or (2) they were receiving non-invasive respiratory support and there was a clinical decision to treat with surfactant. For this analysis, only infants born before 26 weeks' gestation were included, and treatment and control groups were combined. We aimed to describe early respiratory trajectories, including the levels of respiratory support and oxygen administered during the first 14 days, and respiratory outcomes at 28 postnatal days and 36 weeks' and 40 weeks' postmenstrual age. The main in-hospital respiratory outcomes were the timing and success of the first extubation, the durations of respiratory support, including oxygen requirements, and outcomes at hospital discharge, such as duration of hospital stay and discharge home on oxygen. PLUSS is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000322336), and follow-up is ongoing. FINDINGS: Between Jan 4, 2018, and March 27, 2023, 1062 infants were recruited to the PLUSS trial, of whom 601 were born before 26 weeks' gestation. 131 (97%) of 135 infants born at 22-23 weeks' gestation were intubated at birth, compared with 163 (74%) of 220 infants born at 24 weeks and 157 (64%) of 246 infants born at 25 weeks. The median postnatal age at first extubation ranged from 15 days (IQR 8-26) in infants born at 22-23 weeks' gestation to 6 days (2-18) in those born at 24 weeks and 3 days (1-10) in those born at 25 weeks. 54 (66%) of 82 infants born at 22-23 weeks' gestation required reintubation, compared with 80 (51%) of 158 infants born at 24 weeks and 72 (38%) of 189 infants born at 25 weeks. The median duration of mechanical ventilation in infants who survived to 36 weeks' postmenstrual age was 36 days (IQR 23-49) in those born at 22-23 weeks' gestation, 26 days (14-39) in those born at 24 weeks, and 12 days (3-27) in those born at 25 weeks. At 40 weeks' postmenstrual age, nine (11%) of 83 surviving infants born at 22-23 weeks' gestation were discharged home, and 63 (85%) of 74 infants still in the hospital were receiving oxygen or respiratory support. By contrast, 36 (23%) of 160 surviving infants born at 24 weeks and 61 (30%) of 204 born at 25 weeks were discharged home, and 97 (78%) of 124 in-hospital infants born at 24 weeks and 79 (55%) of 143 in-hospital infants born at 25 weeks required oxygen or respiratory support. INTERPRETATION: The most preterm infants born at the margins of viability require intensive and prolonged respiratory support. Knowledge of the respiratory trajectories in surfactant-treated infants born before 26 weeks' gestation could assist clinicians in family consultations while also guiding future randomised controlled trials. FUNDING: National Health and Medical Research Council, Australia; Chiesi Farmaceutici.
Free Newsletter

Clinical research that matters. Delivered to your inbox.

Join thousands of clinicians and researchers. No spam, unsubscribe anytime.