Abstract Background: Respiratory distress syndrome (RDS) is the single most important cause of morbidity and mortality in preterm neonates. Early management of RDS is crucial in determining short- and long-term outcomes and studies have established initial respiratory support (IRS) among other factors as an important determinant. Despite preexisting guidelines and advancements in the management of RDS, IRS failure with noninvasive ventilation is common and is associated with unfavorable outcomes. Objective:  This study evaluated the non-invasive initial respiratory support outcomes and associated factors among preterm neonates with respiratory distress syndrome admitted in the newborn unit (NBU) at Moi Teaching and Referral Hospital Eldoret (MTRH), Kenya Methods: Using a prospective observational hospital-based study, preterm neonates ≤ 35weeks admitted at the newborn unit with clinical RDS were followed up for 28 days. The primary outcome was IRS success or failure characterized by not stepping up or stepping up the respiratory support respectively within 72 hours of life and associated maternal and neonatal factors. Descriptive statistics was described using mean ± (SD) for continuous variables and frequencies and percentages for categorical variables. Simple and multinomial regression analysis was performed to evaluate relationship between different IRS methods with outcome variables and a p-value of < 0.05 was considered significant. Results: We enrolled 320 neonates, 172(53.8%) were male with a mean (SD) gestation age of 30.9 (2.95) weeks. The mothers mean age was 27 years, ranging (15-43). 70(22.4%) 95%CI:17.95,27.47] had IRS failure and 243(77.6%) had IRS success. On multivariate analysis IRS success was associated with primiparity (AOR=2.81;95%CI: 1.42, 7.99), birthweight > 1300g (AOR= 5.04;95%CI 1.81, 14.6), low modified Downes score (AOR=26.395%CI 3.37, 230) and normal admission temperatures (AOR=0.32;95%CI 0.12, 0.72) (p= <0.001). Conclusion: Noninvasive ventilation had a high initial respiratory support success. Primiparity, birthweight >1300g, normal admission temperatures and low Downes score were associated with IRS success.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Moi Teaching and Referral Hospital (MTRH) and Moi University School of medicine Institutional research and ethics committee (IREC) approval number IREC FAN/0004043

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