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Published on: August 2, 2024
Characteristics and Outcomes in Preterm Infants with Extubation Failure in the First Week of Life
Katherine Coughlin1, Phoebe Jen2, Anup Katheria3
1Department of Pediatrics, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California.
Insights
Extubation failure in extremely preterm infants is linked to increased neonatal morbidities. Clinical factors like pH, base deficit, and surfactant doses may help predict extubation success, warranting further study.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Extubation readiness in extremely preterm infants is difficult to predict.
- Extubation failure is associated with significant neonatal morbidities.
Purpose of the Study:
- To evaluate characteristics and outcomes of preterm infants experiencing extubation failure within the first week of life.
- To identify potential predictors of early extubation success or failure in extremely preterm neonates.
Main Methods:
- Retrospective chart review of infants born between 24 and 27 weeks' gestational age.
- Comparison of infants who failed extubation (required reintubation) versus those successfully extubated within 7 days of life.
- Analysis of maternal and neonatal outcome measures, including clinical and laboratory data.
Main Results:
- 21.4% of 215 extremely preterm infants failed their first extubation attempt within 7 days.
- Extubation failure was associated with lower pH, increased base deficit, and more surfactant doses prior to the initial extubation.
- Infants failing extubation had higher rates of patent ductus arteriosus, severe intraventricular hemorrhage, posthemorrhagic hydrocephalus, periventricular leukomalacia, and retinopathy of prematurity.
Conclusions:
- Extubation failure in extremely preterm infants is associated with an increased risk of multiple neonatal morbidities.
- pH, base deficit, and surfactant doses before extubation may aid in predicting early extubation success.
- Prospective studies are needed to validate these findings and improve prediction models.
Objective:
This study aimed to evaluate characteristics and outcomes in preterm infants with extubation failures in their first week of life.
Study Design:
Retrospective chart review of infants born between 24 and 27 weeks' gestational age at the Sharp Mary Birch Hospital for Women and Newborns between January 2014 and December 2020 who had an extubation attempt within the first 7 days of life. Infants that were successfully extubated were compared with those who required reintubation in the first 7 days. Maternal and neonatal outcome measures were analyzed.
Results:
A total of 215 extremely preterm infants had an extubation attempt in the first 7 days of life. Forty-six infants (21.4%) failed extubation and were reintubated within the first 7 days. Infants who failed extubation had a lower pH (p < 0.01), increased base deficit (p < 0.01), and more surfactant doses prior to first extubation (p < 0.01). Birth weight, Apgar scores, antenatal steroid doses, and maternal risk factors such as preeclampsia, chorioamnionitis, and duration of ruptured membranes were not different between success and failure groups. Rates of moderate to large patent ductus arteriosus (p < 0.01), severe intraventricular hemorrhage (p < 0.01), posthemorrhagic hydrocephalus (p < 0.05), periventricular leukomalacia (p < 0.01), and retinopathy of prematurity stage 3 or greater (p < 0.05) were higher in the failure group.
Conclusion:
In this cohort of extremely preterm infants that failed extubation in the first week of life, there were as increased risk of multiple morbidities. Base deficit, pH, and number of surfactant doses prior to first extubation may be useful tools in predicting which infants are likely to have early extubation success, but this needs prospective study.
Key Points:
· Predicting extubation readiness in preterm infants remains challenging.. · Extubation failure is associated with multiple neonatal morbidities.. · Infant clinical characteristics may help predict extubation failure..
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