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J Pediatr. 2017 Oct;189:113-119.e2. doi: 10.1016/j.jpeds.2017.04.050. Epub 2017 Jun 7.

Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation.

Collaborators (129)

Jobe AH11, Caplan MS12, Polin RA13, Laptook AR14, Oh W14, Hensman AM14, Gingras D14, Barnett S14, Lillie S14, Francis K14, Andrews D14, Angela K14, Walsh MC15, Fanaroff AA15, Newman NS15, Siner BS15, Schibler K16, Donovan EF16, Narendran V16, Bridges K16, Alexander B16, Grisby C16, Mersmann MW16, Mincey HL16, Hessling J16, Goldberg RN17, Auten KJ17, Fisher KA17, Foy KA17, Siaw G17, Stoll BJ18, Buchter S18, Piazza A18, Carlton DP18, Hale EC18, Archer SW19, Poindexter BB20, Lemons JA20, Hamer F20, Herron DE20, Miller LC20, Wilson LD20, Berberich MA21, Blaisdell CJ21, Gail DB21, Kiley JP21, Poole WK22, Cunningham M22, Hastings BK22, Irene AR22, Auman JO22, Huitema CP22, Pickett JW 2nd22, Wallace D22, Zaterka-Baxter KM22, Van Meurs KP23, Stevenson DK23, Ball MB23, Proud MS23, Frantz ID 3rd24, Fiascone JM24, Furey A24, MacKinnon BL24, Nylen E24, Collins MV25, Cosby SS25, Phillips VA25, Rasmussen MR26, Wozniak PR26, Rich W26, Arnell K26, Bridge R26, Demetrio C26, Bell EF27, Widness JA27, Klein JM27, Johnson KJ27, Duara S28, Everett-Thomas R28, Watterberg KL29, Ohls RK29, Rohr J29, Lacy CB29, Phelps DL30, Laroia N30, Reubens LJ30, Burnell E30, Sánchez PJ31, Rosenfeld CR31, Salhab WA31, Allen J31, Guzman A31, Hensley G31, Lepps MH31, Martin M31, Miller NA31, Solis A31, Vasil DM31, Wilder K31, Kennedy KA32, Tyson JE32, Morris BH32, Harris BF32, Lis AE32, Martin S32, McDavid GE32, Tate PL32, Wright SL32, Yoder BA33, Faix RG33, Burnett J33, Jensen JJ33, Osborne KA33, Spencer C33, Weaver-Lewis K33, O'Shea TM34, Peters NJ34, Sood BG35, Bara R35, Billian E35, Johnson M35, Ehrenkranz RA36, Jacobs HC36, Bhandari V36, Cervone P36, Gettner P36, Konstantino M36, Poulsen J36, Taft J36.

Author information

1
Department of Pediatrics, Wayne State University, Detroit, MI. Electronic address: schawla@dmc.org.
2
Department of Pediatrics, Wayne State University, Detroit, MI.
3
Social, Statistical and Environmental Sciences Unit, Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC.
4
Department of Pediatrics, University of Southwestern Medical Center, Dallas, TX.
5
Department of Pediatrics, Women and Infant Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI.
6
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
7
Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, MD.
8
Department of Pediatrics, UC San Diego Medical Center, UC San Diego School of Medicine, San Diego, CA.
9
Department of Pediatrics, Duke University School of Medicine, Durham, NC.
10
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
11
University of Cincinnati.
12
University of Chicago, Pritzker School of Medicine.
13
Division of Neonatology, College of Physicians and Surgeons, Columbia University.
14
Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island.
15
Case Western Reserve University, Rainbow Babies and Children's Hospital.
16
Cincinnati Children's Hospital Medical Center, University of Cincinnati Hospital and Good Samaritan Hospital.
17
Duke University School of Medicine, University Hospital, Alamance Regional Medical Center, and Durham Regional Hospital.
18
Emory University, Children's Healthcare of Atlanta, Grady Memorial Hospital, and Emory Crawford Long Hospital.
19
Eunice Kennedy Shriver National Institute of Child Health and Human Development.
20
Indiana University, Indiana University Hospital, Methodist Hospital, Riley Hospital for Children, and Wishard Health Services.
21
National Heart, Lung, and Blood Institute.
22
RTI International.
23
Stanford University, Lucile Packard Children's Hospital.
24
Tufts Medical Center, Floating Hospital for Children.
25
University of Alabama at Birmingham, Health System and Children's Hospital of Alabama.
26
University of California-San Diego, Medical Center and Sharp Mary Birch Hospital for Women.
27
University of Iowa.
28
University of Miami, Holtz Children's Hospital.
29
University of New Mexico, Health Sciences Center.
30
University of Rochester Medical Center, Golisano Children's Hospital.
31
University of Texas Southwestern Medical Center at Dallas, Parkland Health and Hospital System and Children's Medical Center Dallas.
32
University of Texas Health Science Center at Houston, Medical School and Children's Memorial Hermann Hospital.
33
University of Utah Medical Center, Intermountain Medical Center, LDS Hospital, and Primary Children's Medical Center.
34
Wake Forest University Baptist Medical Center, Brenner Children's Hospital and Forsyth Medical Center.
35
Wayne State University, Hutzel Women's Hospital and Children's Hospital of Michigan.
36
Yale University, Yale-New Haven Children's Hospital and Bridgeport Hospital.

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.

KEYWORDS:

bronchopulmonary dysplasia; extremely preterm; extubation; neonatal morbidity

PMID:
28600154
PMCID:
PMC5657557
DOI:
10.1016/j.jpeds.2017.04.050
[Indexed for MEDLINE]
Free PMC Article

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