Three-factor nomogram predicts endotracheal IMV in preterm infants receiving pulmonary surfactant within 72 hours

BackgroundEarly identification of preterm infants at risk for invasive mechanical ventilation (IMV) enables timely respiratory support and may reduce ventilation-related harm.ObjectiveTo develop and internally validate a parsimonious prediction model for IMV within 72 h after birth.MethodsWe conducted a single-center retrospective cohort study (July 2023–June 2024) including 1,059 preterm infants admitted within 72 h of life and randomly split them into training (n = 742) and validation (n = 317) sets. Exclusions included chorioamnionitis and deaths ≤ 72 h. Forty-five candidate variables were screened; after multiple imputation, least absolute shrinkage and selection operator (20-fold cross-validation, λ1se) identified three predictors for multivariable logistic modeling: 1-min Apgar score, pulmonary surfactant administration within 72 h, and early-onset sepsis. The primary endpoint was endotracheal IMV lasting ≥ 12 consecutive hours within 72 h of birth. Discrimination, calibration, and decision-curve analysis (DCA) were assessed. Sensitivity analysis restricted early-onset sepsis to culture-proven cases.ResultsIn the validation set, the model achieved an AUC of 0.816; at the optimal probability threshold (0.224), sensitivity, specificity, and accuracy were 0.613, 0.914, and 0.855, respectively. Calibration was good (Brier score 0.096; Hosmer–Lemeshow P = 0.28; expected/observed ratio = 1), and DCA showed net benefit across thresholds 0.10–0.70. Culture-proven analysis yielded AUC 0.830 with similar calibration; a pulmonary surfactant × sepsis interaction was significant (β = −2.531, P = 0.028).ConclusionA three-factor model based on perinatal and early neonatal indicators provides accurate, well-calibrated prediction of IMV within 72 h and is readily implementable for bedside risk stratification; external validation is warranted.