Respiratory support practices and outcomes among very low birth weight infants in a resource-limited setting: a cohort study from Peru

Very low birth weight (VLBW) preterm infants are at high risk of respiratory and systemic complications, particularly in resource-limited settings. Generating local evidence is essential to optimize ventilatory support strategies in these populations. The objective of our study was to describe the perinatal and clinical characteristics, ventilatory support strategies, complications, and comorbidities among VLBW infants born at Hospital Nacional Cayetano Heredia. Single-center observational cohort study based on prospectively collected clinical data including all very low birth weight (VLBW, < 1500 g) preterm newborns admitted to the Neonatal Intensive Care Unit of Hospital Nacional Cayetano Heredia between September 1st 2019 and August 31st 2025. A total of 325 newborns were analyzed, of whom 30.8% weighed < 1000 g. Non-invasive mechanical ventilation (NIMV) was the initial mode of respiratory support in 61.5% of the cohort and was more frequently used in the 1000–1500 g group. Early NIMV failure occurred in 82.1% of infants weighing < 1000 g and in 44.2% of those weighing 1000–1500 g. Invasive mechanical ventilation (IMV) was required in 68.9% of the overall cohort, reaching 95% among infants weighing < 1000 g. Overall, 78.2% received surfactant therapy, with higher use among extremely low birth weight infants. Among survivors, infants weighing < 1000 g required more days of total ventilatory support (median 68 vs. 23 days) and had higher rates of bronchopulmonary dysplasia, sepsis, patent ductus arteriosus, intraventricular hemorrhage, and retinopathy. Mortality was 57% in infants weighing < 1000 g and 11.1% in those weighing 1000–1500 g. Very low birth weight preterm infants treated at our center showed high rates of NIMV failure, substantial need for invasive mechanical ventilation, and a considerable burden of respiratory and systemic complications, particularly among those weighing < 1000 g. These findings underscore the need to strengthen early respiratory management strategies and optimize perinatal care in this setting. not applicable.