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Am J Perinatol
DOI: 10.1055/a-2788-2071
Original Article

High Altitude and Duration of Respiratory Support in Preterm Infants: A Multicenter, Observational Cohort from Latin America

Authors

  • Angela B. Hoyos 

    1   Division of Neonatology, El Bosque University, Bogota, DC, Colombia

  • Pablo Vasquez-Hoyos 

    2   Hospital de San José Bogotá, DC, Colombia
    3   Universidad Nacional and Universidad Ciencias de la Salud, Bogotá, DC, Colombia

  • Horacio Osiovich 

    4   Department of Pediatrics, BC Women's Hospital, University of British Columbia, Vancouver, Canada

  • Carlos A. Fajardo 

    5   Cumming School of Medicine, University of Calgary, Alberta, Canada

  • Ariel A. Salas 

    6   Helping Babies Feed Program and NEC/Short Bowel Prevention Program, Mother's Milk Bank of Alabama, Birmingham, Alabama, United States
    7   Continuing Care Nursery, University of Alabama at Birmingham, Birmingham, Alabama, United States

  • Carolina Villegas 

    8   Division of Neonatology, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico

  • Fernando Aguinaga 

    9   Division of Neonatology, Metropolitano Hospital, Quito, Ecuador

  • Martha Baez 

    10   Division of Neonatology, El Bosque University, Clinica del Country, Bogota, DC, Colombia

  • Maria Ines Martinini 

    11   Division of Neonatology, Nuestra Señora de las Mercedes Maternity, Tucuman, Argentina
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Abstract

Objective

Respiratory support use in neonatal intensive care units (NICUs) varies worldwide, influenced by clinical practices, resources, and patient populations. Whether high-altitude independently affects the duration of respiratory support in preterm infants remains unclear. This study aimed to determine whether altitude is independently associated with the duration of respiratory support in preterm infants ≤32 weeks' gestational age (GA) admitted to Latin American NICUs.

Study Design

We performed a multicenter, observational cohort study by secondary analysis of prospectively collected data from the EpicLatino Network, a registry of NICUs across Latin America (2015–2022). Infants ≤32 weeks who received invasive or non-invasive respiratory support were included; supplemental oxygen delivered via low-flow nasal cannula or oxygen hood was not considered respiratory support, and those with missing outcome data were excluded. The primary outcome was total duration of respiratory support, measured as total days of support until discontinuation, discharge, transfer, or truncation by death. Altitude was classified as high (≥2,000 m) or low (<2,000 m). Multivariable analyses were adjusted for neonatal, maternal, and unit characteristics.

Results

A total of 4,428 infants were included; 2,723 (61.5%) in low-altitude NICUs and 1,705 (38.5%) in high-altitude NICUs. Overall, 81.4% discontinued respiratory support and 18.6% died. Mortality was 19.1% in low-altitude and 17.9% in high-altitude NICUs. Median duration of support was 8 days (interquartile range [IQR]: 5–14) overall, with 9 days (IQR: 4–27) in low-altitude and 7 days (IQR: 3–17) in high-altitude NICUs. High-altitude centers showed shorter respiratory support in unadjusted analyses. After adjustment for neonatal, maternal, and unit factors, altitude was not independently associated with support duration.

Conclusion

After adjustment for neonatal, maternal, and unit factors, altitude was not independently associated with the duration of respiratory support. Importantly, high altitude was never associated with worse outcomes.

Key Points

  • High-altitude NICUs showed shorter respiratory support use, likely reflecting environmental hypoxemia, but this association disappeared after adjusting for clinical and unit factors.

  • Mortality was similar at high and low altitudes, indicating that shorter duration at altitude was not explained by earlier deaths.

  • Altitude may influence initial decisions on invasive support, but patient and institutional characteristics appear more relevant in determining total duration.

Keywords

infant - premature - intensive care units - neonatal - altitude - Latin America - respiration - artificial - NICU - respiratory support

Declaration of GenAI Use

During the writing process of this paper, the author(s) used ChatGPT, OpenAI in order to assist with language editing, formatting suggestions, and organization of sections (e.g., Abstract, Methods, Discussion). The author(s) reviewed and edited the text and take(s) full responsibility for the content of the paper


Data Availability Statement

The data that support the findings of this study are not publicly available because these data belong to 32 units of Latin America and the Caribbean, and there is a confidential agreement with them, but are available from the corresponding author upon request.


Contributors' Statement

A.B.H.: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing–original draft, writing–review and editing. P.V-H.: Conceptualization, formal analysis, methodology, project administration, software, validation, visualization, writing–original draft, writing–review and editing. H.O.: Formal analysis, investigation, project administration, validation, visualization, writing–original draft, writing–review and editing. C.F.: Methodology, project administration, visualization, writing–review and editing. A.A.S.: Conceptualization, investigation, project administration, validation, visualization, writing–original draft. C.V-A.: Methodology, project administration, validation, visualization, writing–original draft. F.A.: Project administration, visualization, writing–original draft, writing–review and editing. M.B.: Investigation, project administration, validation, visualization, writing–original draft. M.I.M.: Project administration, visualization, writing–original draft.


Ethical Approval

This study is a secondary analysis of a large database called EpicLatino, which collects information from 32 neonatal units across various countries and cities in Latin America. To participate in this database, each unit must obtain approval from its local ethics committee to collect data from newborns. These units submit de-identified data to Sinai Health in Toronto, Canada (Department of Pediatrics/Maternal-Infant Care Research Centre [MiCare]), where the data are stored alongside the Canadian Neonatal Network database. The EpicLatino registry has received IRB (ethical) approval at each participating center for the collection and secondary analysis of deidentified clinical data.


Informed Consent

The use of anonymized data for research purposes qualified for exemption from individual informed consent in accordance with international regulations.




Publication History

Received: 29 September 2025

Accepted: 13 January 2026

Accepted Manuscript online:
14 January 2026

Article published online:
23 January 2026

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