Early extubation attempts reduce length of stay in extremely preterm infants even if re-intubation is necessary
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Updated: Apr 3, 2026
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
M Robbins1, J Trittmann1,2, E Martin3
1Division of Neonatology, Department of Pediatrics, The Ohio State University, OH, USA.
Insights
Early extubation attempts in extremely premature infants reduce hospital stay and bronchopulmonary dysplasia (BPD) risk. This study suggests delaying extubation is unnecessary, even with re-intubation concerns, for better outcomes in extremely low birth weight infants.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Prolonged mechanical ventilation in extremely premature infants is linked to bronchopulmonary dysplasia (BPD).
- Clinical decisions regarding extubation for extremely low birth weight (ELBW) infants are challenging.
- Debate exists on the optimal strategy: continued ventilation versus nasal continuous positive airway pressure (nCPAP), with concerns about repeated intubations.
Purpose of the Study:
- To test the hypothesis that earlier extubation attempts decrease length of hospital stay and BPD incidence.
- To evaluate the impact of early extubation on outcomes in extremely premature infants.
Main Methods:
- A retrospective analysis of a database of infants born at <27 weeks gestation admitted to a NICU over 36 months (n=224).
- Correlation analysis of the day of life (DOL) of the first extubation attempt with birth weight, gestational age, re-intubation, mortality, length of stay (LOS), and need for supplemental oxygen at 36 weeks corrected gestational age (CGA).
Main Results:
- Earlier DOL of the first extubation attempt was inversely correlated with birth weight and gestational age.
- Earlier extubation attempts correlated with a higher likelihood of re-intubation but not mortality.
- In survivors, earlier extubation was associated with shorter LOS and reduced need for supplemental oxygen at 36 weeks CGA.
Conclusions:
- Earlier first extubation attempts in extremely premature infants are associated with earlier discharge and reduced BPD development.
- The findings suggest that extubation should not be delayed in extremely premature infants due to concerns about re-intubation.
- This study supports an earlier extubation strategy for improved outcomes in ELBW infants.
Objective:
Prolonged mechanical ventilation in the extremely premature infant is associated with the development of bronchopulmonary dysplasia (BPD). Clinically, the decision to extubate the extremely low birth weight (ELBW) infant can be difficult. There is continued debate regarding whether it is better for an ELBW infant to remain on the ventilator or to extubate to nasal constant positive airway pressure (nCPAP). It has also been argued that repeated intubations may be detrimental to ELBW infants. We tested the hypothesis that earlier extubation attempts would decrease length of hospital stay and BPD.
Study Design:
A database maintained on infants born at <27 completed weeks gestation admitted to our all referral NICU for a 36 month period was queried (n = 224).
Results:
Day of life (DOL) of the first extubation attempt was inversely correlated with birth weight (p < 0.001) and gestational age (p < 0.01). The DOL of the 1st extubation attempt correlated with the need for re-intubation (p < 0.001), but not with mortality (p = 0.27). In survivors, earlier DOL of 1st extubation attempt was associated with shorter LOS (p < 0.001). Earlier DOL of the 1st extubation attempt was associated with less need for supplemental oxygen (p < 0.001) at 36 weeks CGA, while re-intubation was not (p = 0.50).
Conclusion:
In our cohort of extremely premature infants, the earlier the first extubation attempt the sooner the patient was discharged home and the less likely to develop BPD. Our study suggests that extubation should not be delayed in extremely premature infants due to fears of need for re-intubation.
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