Success Rate and Associated Clinical Factors of Early Extubation in the Preterm Neonate Below 29 weeks of Gestation
CPS ePoster Library. Preziosi A. Jun 25, 2015; 99149; 86
Anna-Maria Preziosi
Anna-Maria Preziosi
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Abstract
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Success Rate and Associated Clinical Factors of Early Extubation in the Preterm Neonate Below 29 weeks of Gestation

Anna-Maria Preziosi MD, Anne Monique Nuyt MD, Keith J. Barrington MD, Ahmed Moussa MD.

Division of Neonatology, Department of Pediatrics, Ste-Justine University Hospital and Research Center
University of Montreal, Quebec, Canada

Background:
Mechanical ventilation in preterm neonates is associated with adverse health outcomes. Early extubation may mitigate these risks. Success rate and associated factors of early extubation are not clearly described.

Objective:
Assess success rate of early extubation in infants < 29 weeks gestation and identify factors associated with extubation outcome.

Methods:
Retrospective cohort study in a level 3 NICU (CHU Ste Justine, Montreal, Canada). Neonates born in 2012 and 2013 at < 29 weeks gestation intubated in the first 7 days of life and extubated in the following 72 hours were included. Infants with congenital anomaly or that died before extubation were excluded. Primary outcome was success of early extubation (not requiring reintubation for > 72 hours). Secondary outcome was to identify factors associated with extubation success. Chi2 was used for categorical variables, independent t-test was used for continuous variables and multiple logistic regression (MLR) was performed to identify factors contributing to extubation success.

Results:
Of the 209 patients born at < 29 weeks gestation during the study period, 76 were included. Characteristics of infants who remained extubated (success) vs. were reintubated (failure) are presented. There were no differences in pre-extubation ventilatory parameters.

Table.
Failure n = 29 (38.2%) Success n = 47 (61.8%) p
Gestational age (weeks) 26 5/7 ± 1 27 4/7 ± 1 ˂ 0.01
Birth weight (grams) 889 ± 224 1022 ± 218 0.01
Male 21 (72.4) 25 (53.2) 0.15
IUGR 3 (10.3) 5 (10.6) 1.00
Chorioamnionitis 3 (10.3) 2 (4.3) 0.36
Oligohydramnios 4 (13.8) 3 (6.4) 0.41
PPROM 5 (17.2) 13 (27.7) 0.41
Gestational diabetes 3 (10.3) 9 (19.1) 0.12
Prenatal steroids 18 (62.1) 32 (68.1) 0.82
Prenatal MgSO4 5 (17.2) 10 (21.3) 0.77
C-section 21 (72.4) 30 (63.8) 0.47
DOL at intubation 1 +/- 0 1 +/- 1 0.32
Age (days) at extubation 3 +/- 1 3 +/- 2 0.27
Surfactant treatment 28 (96.6) 37 (78.7) 0.04
Post extubation 0.28
CPAP 0 (0) 3 (6.4)
NIPPV 29 (100) 44 (94)
PDA 17 (58.6) 17 (36.2) 0.06
Late onset sepsis 3 (10.3) 0 (0) 0.05
*Mean +/- SD or n (%)

Multiple logistic regression identified as significant birthweight, with increased odds of success of 1.003 per gram increase in BW (p ˂ 0.05, 95% CI 1.000 – 1.005) and diagnosis of PDA in the first seven days of life as a significant deterrent to extubation success with OR 0.25 (p ˂ 0.05, CI 0.078 – 0.81, 95%) of PDA in those succeeding. Patients succeeding early extubation had decreased risk of severe ROP or death with an OR of 0.27 (p = 0.04, 95%CI 0.08 – 0.92).

Conclusion
In our cohort of infants < 29 weeks gestation, early extubation succeeded in around 2/3 of patients. Birthweight and PDA might be a significant contributor to extubation outcome. Patients succeeding extubation had decreased risk of severe ROP or death.
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