Age at First Extubation Attempt and Death or Respiratory Morbidities in Extremely Preterm Infants

Abstract

To describe the timing of first extubation in extremely preterm infants and explore the relationship betweenage at first extubation, extubation outcome, and death or respiratory morbidities. In this subanalysis of a multicenter observational study, infants with birth weights of 1250g or less and intubated within 24hours of birth were included. After describing the timing of first extubation, age at extubation was divided into early (within 7days from birth) vs late (days of life 8-35), and extubation outcome was divided into success vs failure (reintubation within 7days after extubation), to create 4 extubation groups: early success, early failure, late success, and late failure. Logistic regression analyses were performed to evaluate associations between the 4 groups and death or bronchopulmonary dysplasia, bronchopulmonary dysplasia among survivors, and durations of respiratory support and oxygen therapy. Of the 250 infants included, 129 (52%) were extubated within 7days, 93 (37%) between 8 and 35days, and 28 (11%) beyond 35days of life. There were 93, 36, 59, and 34 infants with early success, early failure, late success, and late failure, respectively. Although early success was associated with the lowest rates of respiratory morbidities, early failure was not associated with significantly different respiratory outcomes compared with late success or late failure in unadjusted and adjusted analyses. In a contemporary cohort of extremely preterm infants, early extubation occurred in 52% of infants, and only early and successful extubation was associated with decreased respiratory morbidities. Predictors capable of promptly identifying infants with a high likelihood of early extubation success or failure are needed.