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

M. Robbins, J. Trittmann, E. Martin, Kristina M. Reber, L. Nelin*, E. Shepherd

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

OBJECTIVE: 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. STUDY DESIGN: 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). RESULTS: Day of life (DOL) of the first extubation attemptwas 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). CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)91-97
Number of pages7
JournalJournal of Neonatal-Perinatal Medicine
Volume8
Issue number2
DOIs
StatePublished - Jul 31 2015

Keywords

  • Extremely low birth weight
  • bronchopulmonary dysplasia
  • nasal continuous positive airway pressure

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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