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Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation
- Source :
- The Journal of pediatrics. 189
- Publication Year :
- 2017
-
Abstract
- Objectives To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. Study design This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Results Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/ bronchopulmonary dysplasia (OR 3.27). Conclusions Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. Trial registration ClinicalTrials.gov : NCT00233324 .
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Positive pressure
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
030225 pediatrics
Fraction of inspired oxygen
medicine
Intubation
Humans
030212 general & internal medicine
Continuous positive airway pressure
Treatment Failure
Respiratory Distress Syndrome, Newborn
business.industry
Infant, Newborn
Gestational age
Pulmonary Surfactants
medicine.disease
Surgery
Bronchopulmonary dysplasia
Anesthesia
Infant, Extremely Premature
Pediatrics, Perinatology and Child Health
Airway Extubation
Apgar score
Female
Morbidity
business
Infant, Premature
Subjects
Details
- ISSN :
- 10976833
- Volume :
- 189
- Database :
- OpenAIRE
- Journal :
- The Journal of pediatrics
- Accession number :
- edsair.doi.dedup.....8ac02c8edc82d5a5de5ddfd0f8de5bb7