Relationship Between the Respiratory Severity Score and Extubation Failure in Very-Low-Birth-Weight Premature Infants

The objective of the study is to investigate the utility of the respiratory severity score (RSS), an easy-to-use, non-invasive respiratory failure assessment tool that does not require arterial blood sampling, for predicting extubation failure in very-low-birth-weight premature infants.

Demographic characteristics, clinical course, and neonatal morbidities were retrospectively analyzed. Data were obtained from the files of infants who were admitted to our unit between February 2016 and September 2020, were born before 30 weeks' gestation, and had a birth weight <1250 g. Extubation success was defined as no need for reintubation for 72 h after extubation. RSS and RSS/kg values before each patient's first planned extubation were calculated. RSS values before extubation and risk factors for extubation failure were compared between infants in the successful and failed extubation groups.

Our study enrolled 142 infants who met the inclusion criteria. The extubation failure rate was 30.2% (43/142). Early gestation, low birth weight, male sex, high RSS, grade ≥3 intraventricular hemorrhage, late-onset sepsis, low weight at the time of extubation, and postmenstrual age at the time of extubation were identified as risk factors for extubation failure. In the logistic regression analysis including these risk factors, RSS/kg remained a significant risk factor, along with late-onset sepsis (OR 25.7 [95% CI: 5.70-115.76]; p<0.001). In the receiver operating characteristic analysis of RSS values, at a cutoff value of 2.13 (area under the curve: 82.5%), RSS/kg had 77% sensitivity and 78% specificity (p<0.001). The duration of mechanical ventilation and hospital stay were prolonged in infants with extubation failure. The incidence rates of stage ≥3 retinopathy of prematurity and stage ≥2 necrotizing enterocolitis were also higher.

High RSS and RSS/kg values were closely associated with extubation failure and can be used as a non-invasive assessment tool to support clinical decision-making, and thus reduce the rate of extubation failure.