Duration of Respiratory Support in Latin American NICUs: A Competing Risks Analysis by Altitude
Bibliographic record
Abstract
Objective: We aimed to determine whether the duration of assisted ventilation is independently associated with receiving care at low- or high-altitude NICUs in Latin America among preterm infants born at ≤32 weeks of gestation. Study Design: We conducted a multicenter observational cohort study using data from the EpicLatino registry (2015–2022), which contains prospectively collected clinical information from 32 NICUs in Latin America and the Caribbean. Assisted ventilation was defined as the use of any form of invasive mechanical ventilation, non-invasive positive pressure ventilation, or high-flow nasal cannula. Altitude was categorized as high (≥2,000 meters above sea level) or low (<2,000 meters). We used competing risks regression and mixed-effects models to evaluate the association between altitude and the duration of assisted ventilation, adjusting for clinical characteristics and center-level variation. Results: We included 4,428 preterm infants; 81.4 % (n = 3,604) had assisted ventilation discontinue and 18.6 % (n = 824) died during hospitalization. The median duration of respiratory support was 8 days (4–23 IQR). In unadjusted analyses, infants in high-altitude centers (≥2,000 meters) had shorter durations of ventilation than those at lower altitudes (14 vs. 21 days; p < 0.001). In multivariable models adjusted for gestational age, necrotizing enterocolitis, admission period, and inborn status, altitude was not significantly associated with ventilation duration. A Cox model with shared frailty by center (HR = 1.17; 95 % CI: 0.87–1.57; p = 0.289), and a competing risks regression model with fixed effects for center (SHR = 1.09; 95 % CI: 0.86–1.39; p = 0.47). Conclusions: Observed differences in the duration of assisted ventilation between high- and low- altitude centers were not independently associated with altitude after adjusting clinical characteristics and center. These findings suggest that institutional factors may explain much of the variation in ventilation practices. Standardized, context-adapted respiratory care protocols could help reduce practice variability across NICUs in the region.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".