Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants
Although antenatal steroids and early use nasal continuous positive airway pressure (NCPAP) have significantly improved outcomes of neonatal respiratory distress syndrome, intubation with ventilator support is still commonly required in extremely low birth weight (ELBW) infants. The optimal timing o...
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| Format: | Article |
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Elsevier
2017-04-01
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| Series: | Pediatrics and Neonatology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1875957216300663 |
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| author | Shih-Hsin Wang Jyun-You Liou Chien-Yi Chen Hung-Chieh Chou Wu-Shiun Hsieh Po-Nien Tsao |
| author_facet | Shih-Hsin Wang Jyun-You Liou Chien-Yi Chen Hung-Chieh Chou Wu-Shiun Hsieh Po-Nien Tsao |
| author_sort | Shih-Hsin Wang |
| collection | DOAJ |
| description | Although antenatal steroids and early use nasal continuous positive airway pressure (NCPAP) have significantly improved outcomes of neonatal respiratory distress syndrome, intubation with ventilator support is still commonly required in extremely low birth weight (ELBW) infants. The optimal timing of extubation in ELBW infants remains unclear.
Methods: We retrospectively analyzed all ELBW preterm infants who were admitted to our neonatal intensive care unit (NICU) from January 2009 to December 2013. Demographic, ventilation, and arterial blood gas analysis results prior to and 2 hours after extubation were collected. Extubation failure was defined as reintubation due to deterioration of respiratory condition within 7 days after extubation. Risk factors for extubation failure were analyzed.
Results: In total, 173 ELBW infants were born and admitted to our NICU during these 5 years. Among these 173 infants, 77 (44.5%) used NCPAP only during their hospitalization (20 diagnosed with chronic lung disease (CLD), 25.9%). Among the 95 patients that required intubation, 27 patients expired so extubation was not attempted. Sixteen of 68 (23.5%) survival cases required reintubation within 7 days after extubation. We found that gestational age, birth body weight, and sex ratio did not differ between the successful extubation group and the failed extubation group. Univariate analysis showed that the failed extubation group had a lower arterial pH right before and 2 hours after extubation, with a lower bicarbonate level after extubation. Further multivariate logistic regression analysis revealed an association between poor acid-base homeostasis 2 hours after extubation (pH < 7.3 and HCO3 < 18 mM/L) and extubation failure (odds ratio 4.56 and 6.187 and 95% confidence interval: 1.263∼16.462 and 1.68∼22.791, respectively).
Conclusion: This study shows that nearly half of ELBW infants do not require intubation. Among ELBW infants who require invasive ventilator support, those who have lower postextubation arterial pH and bicarbonate levels are at high risk of extubation failure. |
| format | Article |
| id | doaj-art-e1425047411040508ef4e17f68e41017 |
| institution | DOAJ |
| issn | 1875-9572 |
| language | English |
| publishDate | 2017-04-01 |
| publisher | Elsevier |
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| series | Pediatrics and Neonatology |
| spelling | doaj-art-e1425047411040508ef4e17f68e410172025-08-20T03:09:54ZengElsevierPediatrics and Neonatology1875-95722017-04-0158214515010.1016/j.pedneo.2016.01.006Risk Factors for Extubation Failure in Extremely Low Birth Weight InfantsShih-Hsin Wang0Jyun-You Liou1Chien-Yi Chen2Hung-Chieh Chou3Wu-Shiun Hsieh4Po-Nien Tsao5Department of Pediatrics, National Taiwan University Hospital Children's Hospital, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital Children's Hospital, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital Children's Hospital, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital Children's Hospital, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital Children's Hospital, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital Children's Hospital, Taipei, TaiwanAlthough antenatal steroids and early use nasal continuous positive airway pressure (NCPAP) have significantly improved outcomes of neonatal respiratory distress syndrome, intubation with ventilator support is still commonly required in extremely low birth weight (ELBW) infants. The optimal timing of extubation in ELBW infants remains unclear. Methods: We retrospectively analyzed all ELBW preterm infants who were admitted to our neonatal intensive care unit (NICU) from January 2009 to December 2013. Demographic, ventilation, and arterial blood gas analysis results prior to and 2 hours after extubation were collected. Extubation failure was defined as reintubation due to deterioration of respiratory condition within 7 days after extubation. Risk factors for extubation failure were analyzed. Results: In total, 173 ELBW infants were born and admitted to our NICU during these 5 years. Among these 173 infants, 77 (44.5%) used NCPAP only during their hospitalization (20 diagnosed with chronic lung disease (CLD), 25.9%). Among the 95 patients that required intubation, 27 patients expired so extubation was not attempted. Sixteen of 68 (23.5%) survival cases required reintubation within 7 days after extubation. We found that gestational age, birth body weight, and sex ratio did not differ between the successful extubation group and the failed extubation group. Univariate analysis showed that the failed extubation group had a lower arterial pH right before and 2 hours after extubation, with a lower bicarbonate level after extubation. Further multivariate logistic regression analysis revealed an association between poor acid-base homeostasis 2 hours after extubation (pH < 7.3 and HCO3 < 18 mM/L) and extubation failure (odds ratio 4.56 and 6.187 and 95% confidence interval: 1.263∼16.462 and 1.68∼22.791, respectively). Conclusion: This study shows that nearly half of ELBW infants do not require intubation. Among ELBW infants who require invasive ventilator support, those who have lower postextubation arterial pH and bicarbonate levels are at high risk of extubation failure.http://www.sciencedirect.com/science/article/pii/S1875957216300663ELBWextubation failurerisk factor |
| spellingShingle | Shih-Hsin Wang Jyun-You Liou Chien-Yi Chen Hung-Chieh Chou Wu-Shiun Hsieh Po-Nien Tsao Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants Pediatrics and Neonatology ELBW extubation failure risk factor |
| title | Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants |
| title_full | Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants |
| title_fullStr | Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants |
| title_full_unstemmed | Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants |
| title_short | Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants |
| title_sort | risk factors for extubation failure in extremely low birth weight infants |
| topic | ELBW extubation failure risk factor |
| url | http://www.sciencedirect.com/science/article/pii/S1875957216300663 |
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