Low Birth Weight Preterm Infants Research Articles

An exploratory study of clinical factors associated with IGF-1 and IGFBP-3 in preterm infants.

Despite advances in parenteral nutrition, postnatal growth failure in very low birthweight (VLBW) preterm infants is common and associated with chronic health problems. Insulin-like growth factor 1 (IGF-1) is positively associated with improved infant growth, but factors which promote IGF-1 levels in this population have not been clearly identified. The objective of this study was to explore early factors that influence IGF-1 in VLBW preterm infants. VLBW infants were enrolled into a prospective, randomized controlled nutrition trial (N = 87). Outcome measures included IGF-1 and IGFBP-3 levels measured at 35 weeks PMA. Linear regression analyses tested the relationships between candidate clinical predictors and levels of IGF-1 and IGFBP-3. Higher protein intake, longer duration of parenteral nutrition, and lower IGFBP-3 levels at 1 week of life were associated with lower IGF-1 levels at 35 weeks PMA. Neither early markers of insulin resistance nor degree of illness were associated with IGF-1 levels at 35 weeks PMA. Optimization of early nutrient intake, and attention to route of delivery, may have a lasting influence on IGF-1/IGFBP-3, and in turn, long-term health outcomes. In very low birthweight preterm infants, early protein intake, duration of parenteral nutrition, and insulin-like growth factor binding protein 3 (IGFBP-3) levels at 1 week of life are positively associated with insulin-like growth factor 1 (IGF-1) levels at 35 weeks postmenstrual age. Data from this study highlight the influence of early nutrition on components of the endocrine axis in preterm infants. Strategies aimed at early initiation of enteral nutrition, as well as optimizing composition of parenteral nutrition, may bolster hormones involved in promoting preterm infant growth.

Cue-based feeding in the NICU-a pathway to earlier oral feeding of preterm infants.

To compare volume-driven and cue-based feeding of low birth weight preterm infants, regarding short-term outcomes, including transition to oral feeds, weight gain, and length of stay. This was a retrospective cohort study. Feeding and weight gain outcomes were compared between infants fed by volume-driven and cue-based feeds. The groups were subdivided by birth weight categories. The study group included 240 low birth weight preterm infants born before 34 weeks of gestation, 120 infants fed by volume-driven feeding were compared to 120 infants fed by cue-based feeding. The groups were sub-analyzed by birth weight categories: <1,500 g and 1,500-2,500 g. Study groups were comparable regarding baseline characteristics and neonatal morbidities. Infants fed by cue-based feeding were more likely to achieve full oral feeding faster and at an earlier gestational age. Infants with a birth weight <1,500 g were less likely to experience adverse respiratory episodes during cue-based feeding. Although the rate of weight gain was reduced in cue-based feeding in the heavier infant group, discharge weight, breastfeeding rates, and length of stay were comparable between the groups. Cue-based feeding results in faster transition to full oral feeding in very low birth weight preterm infants and at an earlier gestational age.

Effect of Kangaroo Mother Care on Weight Gain in Low Birth Weight Preterm Infants

Background: Preterm birth, defined as delivery before the 37th week of pregnancy, often results in low birth weight and complex medical issues, necessitating additional care. Kangaroo Mother Care (KMC), which involves skin-to-skin contact with the mother or caregiver, is a recommended care approach for stable low birth weight infants. This study aimed to assess the impact of KMC on the weight gain of low birth weight preterm infants. Methods: This quasi-experimental study was conducted at the premature care unit of Al-Zahraa Teaching Hospital in Al-Najaf, Iraq, from May 2023 to April 2024. The study included 25 mother-infant dyads, where infants were preterm (&lt;37 weeks gestation) and had a birth weight of &lt;2000 grams. The intervention involved mothers practicing KMC for ≥6 hours/day. Data on gestational age, birth weight, gender, mode of delivery, feeding type, and weight gain were collected. Infant weight was measured at enrollment and discharge. Statistical analysis was performed using Jamovi software version 25, with significance set at P &lt; 0.05. Results: The mean age of infants in the KMC group was 13.6±5.7 days, with 56% males and 44% females. Most infants (92%) had a birth weight of &lt;1500 grams. There was a significant weight improvement at discharge (1178.8 ± 239.6 g) compared to admission (1094.8 ± 270.6 g), with an average weight gain of 85 grams (P &lt; 0.001). Additionally, 72% of infants in the KMC group were exclusively breastfed. Conclusion: KMC significantly improves weight gain and breastfeeding rates in low birth weight preterm infants. The findings support the implementation of KMC as an effective care strategy in resource-limited settings to enhance infant health outcomes.

Frequency of ROP Diagnosis and Treatment in Very Low Birth Weight Preterm Infants by Gestational Week and Birth Weight: A Single-Center Experience.

The objective of the study was to evaluate the prevalence and potential risk factors associated with retinopathy of prematurity (ROP) in very low birth weight (BW) ROP patients stratified by different BW categories. This retrospective cohort study examined very low BW patients (≤1500 g) treated at a neonatal intensive care unit and subsequently assessed for ROP at the outpatient clinic. Data on gestational age (GA), BW, ROP severity, treatments, and outcomes were collected following international ROP classification criteria. Patients with type 1 ROP and aggressive ROP received treatment. Patients were categorized based on 250 g BW intervals, and ROP frequency and treatment rates were assessed by GA. In this study, 116 patients, comprising 60.3% of females and 39.7% of males, were analyzed. The GA ranged from 23 to 34 weeks, with a mean of 30.03±2.64 weeks, while the mean BW was 1108±275 g, ranging from 370 g to 1490 g. ROP was present in 49.1% of patients and 19.8% required treatment. Lower BW and GA were significantly associated with ROP (p<0.05). ROP incidence and treatment rates varied across BW groups. ROP diagnosis and treatment rates have risen over time, reflecting improvements in intensive care. Categorizing premature infants based on BW facilitates the development of screening criteria tailored to neonatal intensive care units and aids in predicting ROP diagnosis and treatment rates.

Benefits and Risks of Preprepared Parenteral Nutrition for Early Amino Acid Administration in Premature Infants with Very Low Birth Weight.

Administering early parenteral amino acids to very low birth weight (VLBW) premature infants (birth body weight [BBW]<1,500 g) is challenging due to factors such as holidays, cost, and access to sterile compounding facilities. Using advance-prepared parenteral nutrition (PN) may address this issue and should be evaluated for its safety and potential benefits. We extracted data from medical records collected between July 2015 and August 2019. VLBW infants received PN for at least seven days and were split into two groups: the traditional group (n=30), which initially received a glucose solution and then PN on workdays, and the pre-preparation group (n=16), which received advance-prepared PN immediately upon admission to the neonatal intensive care unit. The median BBWs of the traditional and pre-preparation groups were 1,180.0 vs. 1,210.0 g. In the initial two days, the pre-preparation group had a significantly higher amino acid intake (2.23 and 2.24 g/kg/d) than the traditional group (0 and 1.78 g/kg/d). The pre-preparation group exhibited greater head circumference growth ratio relative to birth (7th day: 1.21% vs. -3.57%, p=0.014; 21st day: 7.71% vs. 3.31%, p=0.017). No significant differences in metabolic tolerance were observed. Advanced preparation of PN can be safely implemented in VLBW preterm infants, offering advantages such as early, higher amino acid intake and improved head circumference growth within the first 21 days post-birth. This strategy may serve as a viable alternative in settings where immediate provision of sterile compounding facilities is challenging.

Causes of Preterm and Low Birth Weight Babies in Pakistan: A Comprehensive Analysis

Preterm birth and low birth weight are critical public health concerns globally, contributing to significant neonatal morbidity and mortality. As a developing country, Pakistan faces substantial challenges in addressing these issues. This paper aims to provide a comprehensive analysis of the causes of preterm birth and low birth weight babies in Pakistan. Through an exploration of socioeconomic, healthcare, maternal, and environmental factors, the paper seeks to shed light on the complex interplay of factors contributing to this problem. Understanding these causes is essential for designing effective interventions and policies to reduce the incidence of preterm birth and low birth weight, ultimately improving maternal and neonatal health outcomes in Pakistan.

Foetomaternal Outcomes in Pregnant Women with Corrected vs Non corrected Heart Disease: A Cross-sectional Analysis at a Tertiary Care Institute of Eastern India

Introduction: Cardiac disease in pregnancy remains a major concern, particularly in developing countries like India. Pregnancy in women with heart disease increases the risk of maternal and foetal complications. Approximately 1% to 4% of pregnant women have concomitant cardiac disease. Aim: To examine the foetomaternal outcomes of pregnant women in the corrected vs. non corrected heart disease groups. Materials and Methods: This was a cross-sectional study conducted in the Department of Obstetrics and Gynaecology at IPGME&amp;R, Kolkata, West Bengal, India, from February 2020 to July 2021. A total of 50 pregnant women were included in the present study, with 25 in the corrected heart disease group and 25 in the non corrected heart disease group. Foetomaternal outcomes, including intrapartum complications, maternal intensive care unit admission, mode of delivery, and foetal complications, were observed. Comparative analyses were conducted using the Student’s t-test and Chi-square test. The p-values &lt;0.05 was considered statistically significant. Results: Data from the present study showed that out of a total of 50 pregnant women with heart disease, the majority (60%) were young (≤25 years). Approximately 48% of women were in their second pregnancy. The most common cardiac lesion in the corrected group was closure of Atrial Septal Defect (ASD) in 8 (16%) cases, while in the non corrected group, the most common was mitral regurgitation in 11 (22%) cases. In the corrected heart disease group, 15 (30%) had a caesarean section and 10 (20%) delivered vaginally, whereas in the non corrected group, 17 (34%) had a caesarean section and 8 (16%) delivered vaginally. Adverse cardiac events occurred in 2 (4%) of the corrected group, whereas 11 (22%) were observed in the non corrected group (p-value=0.0088, significant). Preterm birth and low birth weight babies were more common in the non corrected heart disease group (p-value=0.0449, significant). Conclusion: The study concludes that most women with cardiac disease are young. Compared to the Corrected Group of Heart Disease (CGHD), the non corrected group of pregnant women are more likely to experience severe cardiac complications and require admission to the intensive care unit. The foetomaternal outcome is better in the corrected group. Successful management of pregnant women with heart disease requires a comprehensive multidisciplinary approach to optimise foetomaternal outcomes.

Early-onset neonatal sepsis with Haemophilus influenzae in a premature low birth weight newborn – case report

Prior to routine active immunization, Haemophilus influenzae was the leading cause of bacterial meningitis and other invasive bacterial disease among children. Although it is listed as one of the pathogenic causes of early-onset neonatal sepsis, it’s a relatively infrequent cause of it. The onset of a clinical syndrome along with isolation of the bacteria in the first 72 hours of life defines neonatal sepsis and often presents as bacteremia, pneumonia or meningitis. We present the case of a preterm low birth weight infant with Haemophilus influenzae sepsis. Considering the high neonatal mortality and morbidity of these infections, cultures should be reconsidered. Prompt antibiotic therapy may not be enough in positive outcome of these patients.

Evaluating the Impact of an App-Delivered Mindfulness Meditation Program to Reduce Stress and Anxiety During Pregnancy: Pilot Longitudinal Study.

Stress and anxiety during pregnancy are extremely prevalent and are associated with numerous poor outcomes, among the most serious of which are increased rates of preterm birth and low birth weight infants. Research supports that while in-person mindfulness training is effective in reducing pregnancy stress and anxiety, there are barriers limiting accessibility. The aim of this paper is to determine if mindfulness meditation training with the Headspace app is effective for stress and anxiety reduction during pregnancy. A longitudinal, single-arm trial was implemented with 20 pregnant women who were instructed to practice meditation via the Headspace app twice per day during the month-long trial. Validated scales were used to measure participant's levels of stress and anxiety pre- and postintervention. Physiological measures reflective of stress (heart rate variability and sleep) were collected via the Oura Ring. Statistically significant reductions were found in self-reported levels of stress (P=.005), anxiety (P=.01), and pregnancy anxiety (P<.0001). Hierarchical linear modeling revealed a statistically significant reduction in the physiological data reflective of stress in 1 of 6 heart rate variability metrics, the low-frequency power band, which decreased by 13% (P=.006). A total of 65% of study participants (n=13) reported their sleep improved during the trial, and 95% (n=19) stated that learning mindfulness helped with other aspects of their lives. Participant retention was 100%, with 65% of participants (n=13) completing about two-thirds of the intervention, and 50% of participants (n=10) completing ≥95%. This study found evidence to support the Headspace app as an effective intervention to aid in stress and anxiety reduction during pregnancy.

Risk Factors of Retinopathy of Prematurity among Very Preterm and Very Low Birth Weight Infants

Risk Factors of Retinopathy of Prematurity among Very Preterm and Very Low Birth Weight Infants

Lacticaseibacillus rhamnosus and breastmilk are associated with a decreased risk of atopic dermatitis in very low birth weight premature infants.

In this study, we analyse the influence of nutrition during the early neonatal period on the development and prevention of atopic dermatitis (AD) in children with a history of very low birth weight (VLBW). A retrospective cohort study was performed of VLBW preterm infants to assess the risk of their developing AD during childhood, according to nutrition with breastmilk and/or probiotic supplementation during the neonatal period. The analysis focused on nutritional and early childhood follow-up data for 437 newborns, of whom 184 received probiotics up to 36 weeks postmenstrual age. AD was present in 23.5% of the study sample. Of the children who did not develop AD, 44.9% had received probiotics from birth to 36 weeks of gestational age. Therefore, the administration of probiotics to infants at less than 36 weeks postmenstrual age is associated with a protective effect against the development of AD (odds ratio (OR) 0.57; 95% confidence interval (CI) 0.34-0.93). Moreover, a protective interaction was observed between probiotic administration and breastmilk (OR 0.46; 95% CI 0.25-0.82). The adjusted data in the regression model allow us to observe a statistically significant association with the protective effect of Lacticaseibacillus rhamnosus with the development of AD at school age (OR 0.55; 95% CI 0.30-0.99). Probiotic supplementation in VLBW newborns is associated with a decreased risk of subsequent development of AD. Breastmilk strengthens the protective effect of probiotics against the development of AD.

Effects of maternal pulmonary arterial hypertension on fetal hemodynamics and maternal-fetal outcome in late pregnancy.

The aim of this study was to investigate the effects of maternal pulmonary arterial hypertension (PAH) on fetal hemodynamics in the third trimester and to identify hemodynamic indicators associated with adverse maternal and fetal outcomes. We recruited 48 pregnant women with PAH in the third trimester and 32 women with normal pregnancies as controls matched for age and gestational week. Fetal growth and hemodynamic parameters were assessed by two-dimensional and color Doppler. All cases were followed up until delivery and maternal and fetal outcomes were collected. High throughput sequencing method was used to determine differential miRNA patterns in plasma exposed to pulmonary arterial hypertension (PAH) in pregnant women. We then performed the validated of key differentially expressed miRNAs by real-time PCR. Compared with the normal and mild PAH groups, resistance index (RI), pulsatility index (PI) of the fetal umbilical artery (UA) and quantitative ductus venosus (QDV) blood flow were increased in subjects with moderate to severe PAH, while PI and the ratio of peak systolic velocity (PSV) to end-diastolic velocity (EDV) (S/D) of the middle cerebral artery (MCA) were decreased. Compared with the normal group, subjects in the mild and moderate PAH groups had lower neonatal weight, shorter neonatal height, and higher preterm birth rates. In addition, miRNA sequencing data showed that PAH affected the levels of 23 miRNAs in plasma. At the same time, we showed that PAH significantly decreased the level of miR-1255a and increased the level of miR-548ar-3p by real-time PCR. In the group of pregnant women with moderate to severe pulmonary hypertension, there was a higher proportion of preterm births and low birth weight babies. Hemodynamic changes in the fetal UA, MCA, and ductus venosus (DV) during late pregnancy were associated with adverse fetal outcomes. At the same time, miRNA sequencing results showed that miR-1255a and miR-548ar-3p may play an important role in the development of PAH.

The Necessity of Providing Optimal Micronutrients to the Preterm Low Birth Weight Infants for Preventing Long-Term Health Complications in Perspective of Bangladesh

The Necessity of Providing Optimal Micronutrients to the Preterm Low Birth Weight Infants for Preventing Long-Term Health Complications in Perspective of Bangladesh

Outcomes of Patient Care and Factors Associated with the Complications in Very Low Birth Weight Preterm Infants in the Neonatal Intensive Care Unit

This retrospective study determined the outcomes and associated factors with complications among very low birth weight preterm infants (VLBW) in the neonatal intensive care unit at Ramathibodi Chakri Naruebodindra Hospital. A total of 64 newborns with birth weight ≤ 1,500 grams and gestational age ≤ 32 weeks were included from January 1, 2019 to June 30, 2022. The statistics used for data analysis were percentage, mean, and standard deviation of mean. The Chi-square and Fisher's exact test were used for analysis of relationship between the complications. The results showed that a number of baby survivors were 70.31%. The complications were found 33 cases (51.56%). The most common complications were respiratory distress syndrome (92.19%), bronchopulmonary dysplasia (65.63%), and jaundice (81.25%). The related factors with the complications were birth weight and blood transfusions (p-value= 0.003 and 0.013, respectively). This research findings indicated that the VLBW group had a high mortality and complication rate.

The role of blood pressure variability indicators combined with cerebral blood flow parameters in predicting intraventricular hemorrhage in very low birth weight preterm infants.

Hemodynamic instability is the main factor responsible for the development of intraventricular hemorrhage (IVH) in premature newborns. Herein, we evaluated the predictive ability of blood pressure variability (BPV) and anterior cerebral artery (ACA) blood flow parameters in IVH in premature infants with gestational age (GA) ≤32 weeks and birth weight (BW) ≤ 1,500 g. Preterm infants with GA ≤32 weeks and BW ≤ 1,500 g admitted to the neonatal intensive care unit (NICU) of the hospital affiliated to Yangzhou University from January 2020 to January 2023 were selected as the research subjects. All preterm infants were admitted within 1 h after birth, and systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MABP) were monitored at 1-h intervals. The difference between maximum and minimum values (max-min), standard deviation (SD), coefficient of variation (CV), and successive variation (SV) were used as BPV indicators. On the 1st, 3rd, and 7th day after birth, transcranial ultrasound examination was performed to screen for the occurrence of IVH. On the 24 ± 1 h after birth, systolic velocity (Vs), diastolic velocity (Vd), and resistance index (RI) of the ACA were measured simultaneously. Preterm infants were divided into the IVH group and non-IVH group based on the results of transcranial ultrasound examination, and the correlation between BPV indicators, ACA blood flow parameters, and development of IVH was analyzed. A total of 92 premature infants were enrolled, including 49 in the IVH group and 43 in the non-IVH group. There was no statistically significant difference in baseline characteristics such as BW, GA, sex, and perinatal medical history between the two groups of preterm infants (P > 0.05). The SBP SD (OR: 1.480, 95%CI: 1.020-2.147) and ACA-RI (OR: 3.027, 95%CI: 2.769-3.591) were independent risk factors for IVH in premature newborns. The sensitivity and specificity of combined detection of SBP SD and ACA-RI in predicting IVH were 61.2% and 79.1%, respectively. High BPV and ACA-RI are related to IVH in premature infants with GA ≤32 w and BW ≤1,500 g. Combined detection of SBP SD and ACA-RI has a certain predictive effect on early identification of IVH.

Growth Trends of Very Low Birth Weight Preterm Infants Receiving Donor Human Milk Fortified with Bovine Human Milk Fortifier and a Supplemental Protein Modular

Growth Trends of Very Low Birth Weight Preterm Infants Receiving Donor Human Milk Fortified with Bovine Human Milk Fortifier and a Supplemental Protein Modular

Asymptomatic bacteriuria in pregnant women attending antenatal clinic in a tertiary hospital, South-South Nigeria

Asymptomatic bacteriuria is a common problem in pregnancy and is associated with the risk of preterm birth and pyelonephritis if untreated. This study aims to determine the prevalence and aetiology of asymptomatic bacteriuria and the susceptibility pattern in pregnant women attending antenatal clinics in a tertiary hospital in South-South Nigeria. Urine samples from 30 pregnant women were analysed using conventional microbiology techniques, and the mean age of the respondents was 29.57±5.89 years. The prevalence of asymptomatic bacteriuria in this study is 66.6%, with a higher prevalence in the third trimester (73.3%). The subjects aged 31-35 had the highest prevalence of Klebsiella pneumoniae as the common isolate, followed by Escherichia coli at 45% to 40%, respectively. Reflacine was more susceptible to Escherichia coli (87.5%), while ciprofloxacin was more susceptible to Klebsiella pneumoniae (88.8%) in this study. Asymptomatic bacteriuria is not uncommon among antenatal patients in the population studied. Routine urine culture tests should be conducted on all antenatal patients to identify any unsuspecting infection. This measure will go a long way in reducing maternal and obstetric complications associated with pregnancy, such as preterm labour and low birth weight babies.

The value of hematocrit for predicting bronchopulmonary dysplasia in very low birth weight preterm infants.

To determine hematocrit (HCT) and to identify independent risk factors for predicting bronchopulmonary dysplasia (BPD) in preterm infants with very low birth weight (VLBW) infants. This retrospective study included 296 premature infants with VLBW in the neonatal intensive care unit of the First Affiliated Hospital of the University of Science and Technology of China between January 2015 and December 2019. Maternal pregnant information and clinical information as well as hematological parameters of preterm babies were collected and compared. Then the maximum area under the curve of receiver operating characteristic curve was developed to estimate the predictive indicator in the blood. Finally, differential variables together with the predictive index were screened for multiple logistic regression analysis to determine independent prognostic factors for BPD. Infants were divided into a BPD group (134 cases) and a non-BPD group (162 cases). The area under the curve of HCT at postnatal 1 week was 0.737 with the sensitivity of 52.30 % and the specificity of 86.00%. Birth weight (BW) <1.12 kg, gestational age <28.4 weeks, newborn respiratory distress syndrome, mechanical ventilation ≥ 7 days, ventilation associated pneumonia, patent arterial duct, PaO2/FiO2 <300 mm Hg and HCT <0.455 at postnatal 1 week were risk factors for BPD of VLBW infants. HCT levels below 0.455 at 1 week after birth serve as a valuable indicator for the potential development of BPD.

68 Multimodal Monitoring of Hemodynamics in Extremely Low Birth Weight Preterm Infants in a Canadian Tertiary Level Unit: Non-Blinded Randomized Control Trial/MUSE Trial

Abstract Introduction/Background Current approaches for the evaluation and treatment of transitional circulatory issues in preterm infants based primarily on blood pressure (BP) may be harmful. It is essential that these approaches are adequately investigated. This study tests a detailed hemodynamic approach with a multimodal assessment compared to standard approach, using a Vasoactive Ventilation Renal score (VVR) that incorporates inotrope use, ventilation support, and renal function along with inotrope use reflecting cardiorespiratory-renal health. Objectives To determine whether multimodal hemodynamic monitoring will improve cardiorespiratory-renal health as evidenced by decreasing VVR in preterm infants at one week of life. Design/Methods This was a randomized control trial of preterm infants born &amp;lt;29 weeks gestational age who were admitted to a tertiary neonatal intensive care unit between 15 Feb 2019 and 31 Dec 2021. Eligible infants were randomly assigned for the first 72 hours of life to either a multimodal assessment arm (consisting of early targeted neonatal echocardiogram, continuous cerebral near infrared spectroscopy [NIRS] and clinical-biochemical data) or to a standard arm (using clinical-biochemical data only). A comprehensive study guideline was used for hemodynamic assessment in the multimodal arm. Univariate and multivariate analyses compared the two arms. Results 298 infants were screened during the study period and 147 were randomly assigned (75 multimodal arm, 72 standard arm). 68 in the multimodal and 64 in the standard arm were included in the preliminary analysis (Figure 1). Baseline characteristics were similar in both arms (Table 1). The mean VVR scores within 7 days of life were 16.5(SD 15.4) and 18.9(SD 20.2) in the multimodal and standard arm respectively (p=0.451). Mean Ventilation Index scores in the first 72 hours of life were 16.2(SD 15.7) and 17.9(SD 15.5) respectively (p=0.552, Table 1). Peak VVR scores &amp;gt;53 at 7 days were significantly higher in the standard arm (11.1%) than in the multimodal arm (0%), p= 0.005. Outcomes of death, severe intraventricular hemorrhage and length of hospital stay were not statistically different. However, there was a trend toward decreased inotrope use in the multimodal arm compared with the standard arm (16.2% vs. 23.4% respectively, p=0.294). Conclusion In preterm infants, multimodal hemodynamic assessment during the transitional period was not associated with decreased VVR scores that signify improved cardiorespiratory-renal health, but led to lower incidence of VVR score greater than 90th centile and a decreasing trend in inotrope use in the first week of life.

Predictive factors for extubation success in very low and extremely low birth weight preterm infants.

Although invasive mechanical ventilation (IMV) has contributed to the survival of preterm infants with extremely low birth weight (ELBW), it is also associated with unsatisfactory clinical outcomes when used for prolonged periods. This study aimed to identify factors that may be decisive for extubation success in very low birth weight (VLBW) and extremely low birth weight (ELBW) preterm infants. The cohort study included preterm infants with gestational age (GA) <36 weeks, birth weight (BW) <1500 grams who underwent IMV, born between 2015 and 2018. The infants were allocated into two groups: extubation success (SG) or failure (FG). A stepwise logistic regression model was created to determine variables associated with successful extubation. Eighty-three preterm infants were included. GA and post-extubation arterial partial pressure of carbon dioxide (PaCO2) were predictive of extubation success. Infants from FG had lower GA and BW, while those from SG had higher weight at extubation and lower post-extubation PaCO2. Although we found post-extubation PaCO2 as an extubation success predictor, which is a variable representative of the moment after the primary outcome, this does not diminish its clinical relevance since extubation does not implicate in ET removal only; it also involves all the aspects that take place within a specified period (72 hours) after the planned event. GA and post-extubation PaCO2 were predictors for extubation success in VLBW and ELBW preterm infants. Infants who experienced extubation failure had lower birth weight and higher FiO2 prior to extubation.