Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation

Sanjay Chawla, Girija Natarajan, Seetha Shankaran, Benjamin Carper, Luc P. Brion, Martin Keszler, Waldemar A. Carlo, Namasivayam Ambalavanan, Marie G. Gantz, Abhik Das, Neil Finer, Ronald N. Goldberg, C. Michael Cotten, Rosemary D. Higgins

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives: To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. Study design: This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Results: Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/ bronchopulmonary dysplasia (OR 3.27). Conclusions: Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. Trial registration: ClinicalTrials.gov: NCT00233324.

Original languageEnglish (US)
JournalJournal of Pediatrics
DOIs
StateAccepted/In press - Jan 3 2017

Fingerprint

Extremely Premature Infants
Surface-Active Agents
Morbidity
Bronchopulmonary Dysplasia
Continuous Positive Airway Pressure
Apgar Score
Partial Pressure
Oxygen
Intubation
Carbon Dioxide
Gestational Age
National Institute of Child Health and Human Development (U.S.)
Mortality
Random Allocation
Newborn Infant
Pressure
Pregnancy
Research

Keywords

  • Bronchopulmonary dysplasia
  • Extremely preterm
  • Extubation
  • Neonatal morbidity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation. / Chawla, Sanjay; Natarajan, Girija; Shankaran, Seetha; Carper, Benjamin; Brion, Luc P.; Keszler, Martin; Carlo, Waldemar A.; Ambalavanan, Namasivayam; Gantz, Marie G.; Das, Abhik; Finer, Neil; Goldberg, Ronald N.; Cotten, C. Michael; Higgins, Rosemary D.

In: Journal of Pediatrics, 03.01.2017.

Research output: Contribution to journalArticle

Chawla, S, Natarajan, G, Shankaran, S, Carper, B, Brion, LP, Keszler, M, Carlo, WA, Ambalavanan, N, Gantz, MG, Das, A, Finer, N, Goldberg, RN, Cotten, CM & Higgins, RD 2017, 'Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation', Journal of Pediatrics. https://doi.org/10.1016/j.jpeds.2017.04.050
Chawla, Sanjay ; Natarajan, Girija ; Shankaran, Seetha ; Carper, Benjamin ; Brion, Luc P. ; Keszler, Martin ; Carlo, Waldemar A. ; Ambalavanan, Namasivayam ; Gantz, Marie G. ; Das, Abhik ; Finer, Neil ; Goldberg, Ronald N. ; Cotten, C. Michael ; Higgins, Rosemary D. / Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation. In: Journal of Pediatrics. 2017.
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AU - Natarajan, Girija

AU - Shankaran, Seetha

AU - Carper, Benjamin

AU - Brion, Luc P.

AU - Keszler, Martin

AU - Carlo, Waldemar A.

AU - Ambalavanan, Namasivayam

AU - Gantz, Marie G.

AU - Das, Abhik

AU - Finer, Neil

AU - Goldberg, Ronald N.

AU - Cotten, C. Michael

AU - Higgins, Rosemary D.

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N2 - Objectives: To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. Study design: This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Results: Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/ bronchopulmonary dysplasia (OR 3.27). Conclusions: Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. Trial registration: ClinicalTrials.gov: NCT00233324.

AB - Objectives: To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. Study design: This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Results: Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/ bronchopulmonary dysplasia (OR 3.27). Conclusions: Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. Trial registration: ClinicalTrials.gov: NCT00233324.

KW - Bronchopulmonary dysplasia

KW - Extremely preterm

KW - Extubation

KW - Neonatal morbidity

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