Abstract: Objective To investigate the risk factors for ventilator-associated pneumonia (VAP) in preterm infants with gestational age (GA)<32 weeks undergoing mechanical ventilation (MV) and to construct a nomogram model for predicting the occurrence of VAP. Methods A total of 305 preterm infants with GA <32 weeks who were admitted to Xuzhou Maternity and Child Health Hospital and underwent MV from January 2019 to December 2022 were selected and their clinical data were collected for retrospective analysis. Risk factors for VAP were analyzed, and a nomogram model was constructed. Calibration curves and receiver operating characteristic (ROC) curves were plotted to evaluate the model's predictive efficiency, discrimination, and calibration. Results Among the 305 preterm infants undergoing MV, the incidence of VAP was 11.8%. Univariate and multivariate logistic regression analyses identified that low birth weight, sepsis, neonatal pulmonary hemorrhage, use of antibiotics within 24 h before delivery, and ≥2 endotracheal intubation attempts were risk factors for VAP in preterm infants with GA<32 weeks (P<0.05). These factors were used as predictors to construct a nomogram model for predicting VAP in preterm infants with GA <32 weeks. ROC curve analysis showed that the area under the curve (AUC) for the nomogram was 0.769. The consistency index validated using the Bootstrap resampling method was 0.769, indicating good discrimination. The calibration curve closely aligned with the ideal reference line, demonstrating good calibration. Conclusions Low birth weight, sepsis, neonatal pulmonary hemorrhage, use of antibiotics within 24 h before delivery, and ≥2 endotracheal intubation attempts are risk factors for VAP in preterm infants with GA <32 weeks undergoing MV. The constructed nomogram model provides good predictive efficiency for assessing the risk of VAP in the preterm infants.