Age, ventilation impact extubation outcomes in preemies

The likelihood of extubation failure in preterm neonates is high among those with lower gestational and chronological age and higher levels of pre-extubation ventilation support, according to the results of a systematic review and meta-analysis.

Researchers searched multiple online databases for studies assessing the predictors and outcomes of extubation failure, defined as reintubation within 7 days, in preterm neonates. The inclusion criteria were studies that were experimental or observational in nature and a population comprising preterm neonates less than 37 weeks of age.

The main outcome of interest was the link between extubation failure and mortality and/or bronchopulmonary dysplasia (BPD).

The search yielded 8,336 studies, of which 120 were included. Pooled data showed that extubation failure was more likely to occur among neonates with lower gestational age at birth, birthweight, postmenstrual age, and weight at extubation.

A risk factor for extubation failure was higher level of pre-extubation respiratory support (as indicated by lower pre-extubation pH and higher pre-extubation mean airway pressure, fraction of inspired oxygen, and Pco2). When evaluating predictors, machine learning models showed variable accuracy and lower external validity. On the other hand, lung ultrasound showed promise, but scoring systems varied.

In terms of outcomes, extubation failure was associated with higher odds of mortality and/or BPD (pooled odds ratio [OR], 4.7, 95 percent confidence interval [CI], 2.84–7.76) as well as its individual components—mortality (pooled OR, 3.87, 95 percent CI, 2.35–6.36) and BPD (pooled OR, 3.27, 95 percent CI, 2.54–4.21).