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Am J Perinatol 2024; 41(S 01): e1675-e1680
DOI: 10.1055/s-0043-1768245
Original Article

Characteristics and Outcomes in Preterm Infants with Extubation Failure in the First Week of Life

Katherine Coughlin
1   Department of Pediatrics, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California
,
Phoebe Jen
2   Department of Pediatrics, Western University of Health Sciences, Pomona, California
,
Anup Katheria
3   Department of Pediatrics, Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California
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Abstract

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.

Keywords

outcomes - extubation - preterm - morbidities

Ethical Approval

This study was approved by the Sharp Healthcare Institutional Review Board.


Authors' Contributions

K.C. participated in study design, data collection, manuscript writing, and editing; A.K. participated in study design, data analysis, manuscript writing, and editing; P.J. participated in data collection, data analysis, manuscript writing, and editing.




Publication History

Received: 26 January 2023

Accepted: 21 March 2023

Article published online:
18 April 2023

© 2023. Thieme. All rights reserved.

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