Risk factors and clinical outcomes of extubation failure in very early preterm infants: a single-center cohort study
Abstract Background Early extubation success (ES) in preterm infants may reduce various mechanical ventilation-associated complications; however, extubation failure (EF) can cause adverse short- and long-term outcomes. Therefore, the present study aimed to identify differences in risk factors and cl...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Pediatrics |
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| Online Access: | https://doi.org/10.1186/s12887-023-03833-5 |
| _version_ | 1828056636058501120 |
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| author | Su Jeong Park Mi Hye Bae Mun Hui Jeong Seong Hee Jeong NaRae Lee Shin Yun Byun Kyung Hee Park |
| author_facet | Su Jeong Park Mi Hye Bae Mun Hui Jeong Seong Hee Jeong NaRae Lee Shin Yun Byun Kyung Hee Park |
| author_sort | Su Jeong Park |
| collection | DOAJ |
| description | Abstract Background Early extubation success (ES) in preterm infants may reduce various mechanical ventilation-associated complications; however, extubation failure (EF) can cause adverse short- and long-term outcomes. Therefore, the present study aimed to identify differences in risk factors and clinical outcomes between ES and EF in very early preterm infants. Methods This retrospective study was conducted between January 2017 and December 2021. Premature infants born at 32 weeks’ gestational age in whom extubation had failed at least once were assigned to the EF group. Successfully extubated patients with a similar gestational age and birth weight as those in the EF group were assigned to the ES group. EF was defined as the need for re-intubation within 120 h of extubation. Various variables were compared between groups. Results The EF rate in this study was 18.6% (24/129), and approximately 80% of patients with EF required re-intubation within 90.17 h. In the ES group, there was less use of inotropes within 7 days of life (12 [63.2%] vs. 22 [91.7%], p = 0.022), a lower respiratory severity score (RSS) at 1 and 4 weeks (1.72 vs. 2.5, p = 0.026; 1.73 vs. 2.92, p = 0.010), and a faster time to reach full feeding (18.7 vs. 29.7, p = 0.020). There was a higher severity of bronchopulmonary dysplasia BPD (3 [15.8%] vs. 14 [58.3%], p = 0.018), longer duration of oxygen supply (66.5 vs. 92.9, p = 0.042), and higher corrected age at discharge (39.6 vs. 42.5, p = 0.043) in the EF group. The cutoff value, sensitivity, and specificity of the respiratory severity score (RSS) at 1 week were 1.98, 0.71, and 0.42, respectively, and the cutoff value, sensitivity, and specificity of RSS at 4 weeks were 2.22, 0.67, and 0.47, respectively. Conclusions EF caused adverse short-term outcomes such as a higher BPD severity and longer hospital stay. Therefore, extubation in very early preterm infants should be carefully evaluated. Using inotropes, feeding, and RSS at 1 week of age can help predict extubation success. |
| first_indexed | 2024-04-10T20:59:47Z |
| format | Article |
| id | doaj.art-4e1373b54483486aa95f9ffe666deb27 |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-04-10T20:59:47Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-4e1373b54483486aa95f9ffe666deb272023-01-22T12:25:14ZengBMCBMC Pediatrics1471-24312023-01-012311910.1186/s12887-023-03833-5Risk factors and clinical outcomes of extubation failure in very early preterm infants: a single-center cohort studySu Jeong Park0Mi Hye Bae1Mun Hui Jeong2Seong Hee Jeong3NaRae Lee4Shin Yun Byun5Kyung Hee Park6Department of Pediatrics, Pusan National University Hospital, Pusan National University School of MedicineDepartment of Pediatrics, Pusan National University Hospital, Pusan National University School of MedicineDepartment of Pediatrics, Pusan National University Children’s Hospital, Pusan National University School of MedicineDepartment of Pediatrics, Pusan National University Children’s Hospital, Pusan National University School of MedicineDepartment of Pediatrics, Pusan National University Children’s Hospital, Pusan National University School of MedicineDepartment of Pediatrics, Pusan National University Children’s Hospital, Pusan National University School of MedicineDepartment of Pediatrics, Pusan National University Hospital, Pusan National University School of MedicineAbstract Background Early extubation success (ES) in preterm infants may reduce various mechanical ventilation-associated complications; however, extubation failure (EF) can cause adverse short- and long-term outcomes. Therefore, the present study aimed to identify differences in risk factors and clinical outcomes between ES and EF in very early preterm infants. Methods This retrospective study was conducted between January 2017 and December 2021. Premature infants born at 32 weeks’ gestational age in whom extubation had failed at least once were assigned to the EF group. Successfully extubated patients with a similar gestational age and birth weight as those in the EF group were assigned to the ES group. EF was defined as the need for re-intubation within 120 h of extubation. Various variables were compared between groups. Results The EF rate in this study was 18.6% (24/129), and approximately 80% of patients with EF required re-intubation within 90.17 h. In the ES group, there was less use of inotropes within 7 days of life (12 [63.2%] vs. 22 [91.7%], p = 0.022), a lower respiratory severity score (RSS) at 1 and 4 weeks (1.72 vs. 2.5, p = 0.026; 1.73 vs. 2.92, p = 0.010), and a faster time to reach full feeding (18.7 vs. 29.7, p = 0.020). There was a higher severity of bronchopulmonary dysplasia BPD (3 [15.8%] vs. 14 [58.3%], p = 0.018), longer duration of oxygen supply (66.5 vs. 92.9, p = 0.042), and higher corrected age at discharge (39.6 vs. 42.5, p = 0.043) in the EF group. The cutoff value, sensitivity, and specificity of the respiratory severity score (RSS) at 1 week were 1.98, 0.71, and 0.42, respectively, and the cutoff value, sensitivity, and specificity of RSS at 4 weeks were 2.22, 0.67, and 0.47, respectively. Conclusions EF caused adverse short-term outcomes such as a higher BPD severity and longer hospital stay. Therefore, extubation in very early preterm infants should be carefully evaluated. Using inotropes, feeding, and RSS at 1 week of age can help predict extubation success.https://doi.org/10.1186/s12887-023-03833-5Very early preterm infantMechanical ventilationExtubation failureRisk factorsRespiratory severity score |
| spellingShingle | Su Jeong Park Mi Hye Bae Mun Hui Jeong Seong Hee Jeong NaRae Lee Shin Yun Byun Kyung Hee Park Risk factors and clinical outcomes of extubation failure in very early preterm infants: a single-center cohort study BMC Pediatrics Very early preterm infant Mechanical ventilation Extubation failure Risk factors Respiratory severity score |
| title | Risk factors and clinical outcomes of extubation failure in very early preterm infants: a single-center cohort study |
| title_full | Risk factors and clinical outcomes of extubation failure in very early preterm infants: a single-center cohort study |
| title_fullStr | Risk factors and clinical outcomes of extubation failure in very early preterm infants: a single-center cohort study |
| title_full_unstemmed | Risk factors and clinical outcomes of extubation failure in very early preterm infants: a single-center cohort study |
| title_short | Risk factors and clinical outcomes of extubation failure in very early preterm infants: a single-center cohort study |
| title_sort | risk factors and clinical outcomes of extubation failure in very early preterm infants a single center cohort study |
| topic | Very early preterm infant Mechanical ventilation Extubation failure Risk factors Respiratory severity score |
| url | https://doi.org/10.1186/s12887-023-03833-5 |
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