Factors associated with failed extubation in extremely low birth premature newborn: A retrospective observation study

Linda  Ibrahim; Husam Eldin Mokhtar  Salama; Wendy  Gonzales Baldovino; Laveena  Dias; Maricar Nito Yogore

doi:10.23750/abm.v96i3.16585

Factors associated with failed extubation in extremely low birth premature newborn: A retrospective observation study

Authors

Linda Ibrahim Department of Neonatology and Perinatal Care, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar https://orcid.org/0009-0002-6786-8413
Husam Eldin Mokhtar Salama Department of Neonatology and Perinatal Care, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
Wendy Gonzales Baldovino Respiratory therapist, Division of Neonatology and Perinatal Care, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
Laveena Dias Respiratory therapist, Division of Neonatology and Perinatal Care, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
Maricar Nito Yogore Respiratory therapist, Division of Neonatology and Perinatal Care, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar

Keywords:

extubation, extremely low birth weight (ELBW) newborns, bronchopulmonary dysplasia, premature, re-intubation, ventilation

Abstract

Background and aim: Most of the extremely low birth weights (ELBW) are intubated in the delivery room or soon after. Achieving successful extubation is one of the most critical milestones in managing these newborns. This study aimed to evaluate the extubation patterns of ELBW newborns (23 and 27 gestation weeks).

Methods: This population-based retrospective study was conducted at a tertiary neonatal intensive care unit (NICU) in Qatar for 30 months. Data was collected from electronic medical records.

Results: The study comprised 73 ELBW newborns who were successfully extubated and 55 had to be re-intubated, resulting in a failure rate of 42% (55/128). Logistic regression analysis revealed that weight at extubation was significant (AUC = 0.693), birth weight (AUC = 0.702), gestational age (AUC = 0.707), and age at initial extubation are significant predictors of extubation outcome (p < 0.0001). Active patent ductus arteriosus and extubation within < 24 hours after birth caused extubation failure. The administration of two doses of prenatal steroids and one dosage of surfactant exhibited a significant difference between the two groups (P = 0.027 and 0.001, respectively). Neonatal infection was the primary reason for re-intubation after 14 days of life.

Conclusions: The most common risk factors for failed extubation were gestational age of 23–25 weeks, active patent ductus arteriosus, extubation occurring in less than 24 hours after birth, and birth weight under 800 grams. The 7–14-day observation window was the most optimal time frame for reporting the reintubation rate.

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