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目的:分析出生胎龄<32周的极早产儿初始无创持续气道正压（CPAP）呼吸支持失败的危险因素及其不良结局。方法:采取多中心前瞻性观察性队列研究，收集山东新生儿协作网中30家医院新生儿重症监护病房2019年出生的出生胎龄 25~31n +6周极早产儿的围生期资料、临床救治情况和结局。根据生后初始无创CPAP的结局分为失败组和成功组。采用χ2检验或Fisher确切概率法和非参数检验比较两组间危险因素的差异，并对差异有统计学意义的危险因素进一步进行二元Logistic回归分析。n 结果:共纳入极早产儿 1 040例，其中男577例（55.5%），女463例（44.5%）；出生胎龄25~28n +6周195例（18.8%），29~31n +6周845例（81.2%）；出生体重0.30是初始无创CPAP失败的独立危险因素（n OR=0.718、1.847、4.003、6.712、1.948，95%n CI：0.590~0.873、1.130~3.018、2.435~6.579、3.160~14.259、1.189~3.192，均n P<0.05）；失败组的病死率和新生儿肺出血、中重度支气管肺发育不良、重度脑室内出血不良结局的发生率均明显高于成功组（n OR=4.436、26.393、1.998、4.545，95%n CI：2.106~9.344、9.690~71.885、1.031~3.875、1.615~12.795，均n P<0.05）。n 结论:出生胎龄0.30的是初始无创CPAP失败的危险因素。“,”Objective:To analyze the risk factors and the adverse outcomes of failure in non-invasive continuous positive airway pressure (CPAP) as the initial respiratory support in very preterm infants with gestational age at birth <32 weeks.Methods:This multicenter prospective cohort study was conducted from January 1, 2019 to December 31, 2019 based on the data from Shandong Neonatal Network (SNN). Perinatal information, clinical treatment, and the short-term outcomes of very preterm infants with gestational age at birth of 25—31n +6 weeks in 30 neonatal intensive care units (NICU) in SNN were collected. The very preterm infants with non-invasive CPAP as the initial respiratory support were divided into the group of non-invasive CPAP failure and the group of non-invasive CPAP success. The difference in the risk factors between the two groups were tested by χn 2 test or Fisher exact and the Mann-Whitneyn U test, followed by Logistic regression analysis for all the risk factors with statistically significant difference.n Results:A total of 1 040 very preterm infants were included in this study, including 577 males (55.5%) and 463 females (44.5%). There were 195 cases (18.8%) with gestational age of 25-28n +6 weeks, 845 cases (81.2%) with gestational age of 29-31n +6 weeks, 81 cases (7.8%) with birth weight0.30 after birth were independent risk factors for the failure of initially used non-invasive CPAP (n OR=0.718, 1.847, 4.003, 6.712, 1.948; 95%n CI:0.590-0.873, 1.130-3.018, 2.435-6.579, 3.160-14.259, 1.189-3.192; all n P<0.05). The incidence of adverse outcomes in the group of failure was significantly higher than in the group of success, including death, neonatal pulmonary hemorrhage, moderate or severe broncho pulmonary dysplasia (BPD), and severe intraventricular hemorrhage (IVH) (n OR=4.436, 26.393, 1.998, 4.545; 95%n CI:2.106-9.344, 9.690-71.885, 1.031-3.875, 1.615-12.795; all n P<0.05).n Conclusions:The very preterm infants with gestational age at birth0.30 after birth are independent risk factors for the failure of initially used non-invasive CPAP.n