Amer J Perinatol 2017; 34(14): 1458-1463
DOI: 10.1055/s-0037-1604288
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Outcomes of Infants Who Failed to Extubate despite Systemic Corticosteroids

Alain Cuna1, 2, 3, Tamorah Lewis1, 2, 3, Alexandra Oschman2, Hong Ying Dai2, Katie Brophy4, Michael Norberg2, 3, Michael Nyp1, 2, 3, William Truog1, 2, 3
  • 1School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
  • 2Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
  • 3Center for Infant Pulmonary Disorders, Children's Mercy Kansas City, Kansas City, Missouri
  • 4School of Medicine, University of Kansas, Kansas City, Kansas
Further Information

Publication History

08 February 2017

13 June 2017

Publication Date:
13 July 2017 (eFirst)

Abstract

Objective The objective of this study was to assess the outcomes of preterm infants who failed to extubate following initial treatment with steroids.

Materials and Methods This is a retrospective cohort study of ventilator-dependent preterm infants treated with first course of systemic steroids to facilitate extubation. Outcomes of infants who successfully extubated were compared with infants who failed to extubate.

Results In this study, 74 infants (mean gestation 25.4 ± 1.4 weeks and mean birth weight 764 ± 163 g) met inclusion criteria. Of these, 41 (55%) were successfully extubated and 33 (45%) were not. Baseline demographics were similar between the two groups. The primary outcome of severe bronchopulmonary dysplasia (BPD) or death at 36 weeks was higher among infants who failed to extubate (94 vs. 63%, p = 0.002). Severe BPD remained significantly higher even after adjustment for potential confounders (odds ratio: 12.2, 95% confidence interval: 2.1–70.5, p = 0.005). Extubation failure was also associated with substantially higher rate of tracheostomy (32 vs. 5%, p = 0.003) and gastrostomy tube placement (61 vs. 22%, p = 0.001), as well as longer days of hospitalization (179 ± 72 vs. 129 ± 44 days, p = 0.001) and mechanical ventilation (112 ± 89 vs. 52 ± 42 days, p < 0.001).

Conclusion Failure to extubate after first course of systemic steroids for BPD is associated with poor prognostic implications.