Early extubation attempts reduce length of stay in extremely preterm infants even if re-intubation is necessary.

Abstract

Prolonged mechanical ventilation in the extremely premature infant is associated with the development of bronchopulmonary dysplasia (BPD). Clinically, the decision to extubate the extremely low birth weight (ELBW) infant can be difficult. There is continued debate regarding whether it is better for an ELBW infant to remain on the ventilator or to extubate to nasal constant positive airway pressure (nCPAP). It has also been argued that repeated intubations may be detrimental to ELBW infants. We tested the hypothesis that earlier extubation attempts would decrease length of hospital stay and BPD. A database maintained on infants born at <27 completed weeks gestation admitted to our all referral NICU for a 36 month period was queried (n = 224). Day of life (DOL) of the first extubation attempt was inversely correlated with birth weight (p < 0.001) and gestational age (p < 0.01). The DOL of the 1st extubation attempt correlated with the need for re-intubation (p < 0.001), but not with mortality (p = 0.27). In survivors, earlier DOL of 1st extubation attempt was associated with shorter LOS (p < 0.001). Earlier DOL of the 1st extubation attempt was associated with less need for supplemental oxygen (p < 0.001) at 36 weeks CGA, while re-intubation was not (p = 0.50). In our cohort of extremely premature infants, the earlier the first extubation attempt the sooner the patient was discharged home and the less likely to develop BPD. Our study suggests that extubation should not be delayed in extremely premature infants due to fears of need for re-intubation.