Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks

Ohnstad, Mari Oma; Stensvold, Hans Jørgen; Pripp, Are Hugo; Tvedt, Christine Raaen; Jelsness-Jørgensen, Lars-Petter; Astrup, Henriette; Eriksen, Beate Horsberg; Klingenberg, Claus; Mreihil, Khalaf; Pedersen, Tanja; Rettedal, Siren Irene; Selberg, Terje Reidar; Solberg, Rønnaug; Støen, Ragnhild; Rønnestad, Arild

doi:10.1136/bmjpo-2022-001542

Cited by 7 publications

(2 citation statements)

References 33 publications

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“…Consistent with most previous studies [12,[28][29][30][31], birth weight and PMA at extubation were important factors. Infants with lower birth weight and lower PMA at extubation usually have lower brain development, weaker breathing muscles, and lower lung maturity, resulting in spontaneous breathing failures.…”

Section: Discussionsupporting

confidence: 90%

A Nomogram for Predicting Extubation Failure in Preterm Infants with Gestational Age Less than 29 Weeks

Chen

Wu³

et al. 2023

Neonatology

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Introduction: How to avoid reintubations in prematurity remains a hard nut. This study aimed to develop and validate a nomogram for predicting extubation failure in preterm infants who received different modes of noninvasive ventilation as post-extubation support. Methods: This was a secondary analysis of pre-existing data from a large multicenter RCT combined with a multicenter retrospective investigation in three tertiary referral NICUs in China. The training cohort consisted of extubated infants from the RCT and the validation cohort included neonates admitted to the three NICUs in the last 5 years. The nomogram was developed through univariate and multivariate logistic regression analyses of peri-extubation clinical variables. Results: A total of 432 and 183 preterm infants (25 weeks ≤ gestational age [GA] <29 weeks) were, respectively, included in the training cohort and the validation cohort. Lower birth weight, lower Apgar 5-min score, lower postmenstrual age at extubation, lower PO2 and higher PCO2 before extubation, and continuous positive airway pressure rather than nasal intermittent positive pressure ventilation or noninvasive high-frequency oscillatory ventilation after extubation were associated with higher risks of extubation failure (p < 0.05), on which the nomogram was established. In both the training cohort and the validation cohort, the nomogram demonstrated good predictive accuracy (area under the receiver operating characteristic curve = 0.744 and 0.826); the Hosmer-Lemeshow test (p = 0.192 and 0.401) and the calibration curve (R2 = 0.195 and 0.307) proved a good fitness and conformity; and the decision curve analysis showed significant net benefit at the best threshold (p = 0.201). Conclusion: This nomogram could serve as a good decision-support tool when predicting extubation failure in preterm infants with GA less than 29 weeks.

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Section: Discussionsupporting

confidence: 90%

A Nomogram for Predicting Extubation Failure in Preterm Infants with Gestational Age Less than 29 Weeks

Chen

Wu³

et al. 2023

Neonatology

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“…Moreover, if the infant was reintubated, the workload on the day of reintubation was explored. We chose to explore the unit workload on the infant's day of birth (DOB), as the DOB is considered important related to prior research about the importance of the golden hour, suggesting that interventions performed in the first minutes after birth may have long-term consequences in addition to short-term effects on the rate and quality of survival of EP infants (21,22).…”

Section: Data Collectionmentioning

confidence: 99%

Associations between unit workloads and outcomes of first extubation attempts in extremely premature infants below a gestational age of 26 weeks

et al. 2023

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ObjectiveThe objective was to explore whether high workloads in neonatal intensive care units were associated with short-term respiratory outcomes of extremely premature (EP) infants born <26 weeks of gestational age.MethodsThis was a population-based study using data from the Norwegian Neonatal Network supplemented by data extracted from the medical records of EP infants <26 weeks GA born from 2013 to 2018. To describe the unit workloads, measurements of daily patient volume and unit acuity at each NICU were used. The effect of weekend and summer holiday was also explored.ResultsWe analyzed 316 first planned extubation attempts. There were no associations between unit workloads and the duration of mechanical ventilation until each infant’s first extubation or the outcomes of these attempts. Additionally, there were no weekend or summer holiday effects on the outcomes explored. Workloads did not affect the causes of reintubation for infants who failed their first extubation attempt.ConclusionOur finding that there was no association between the organizational factors explored and short-term respiratory outcomes can be interpreted as indicating resilience in Norwegian neonatal intensive care units.

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Long-term non-invasive ventilation in children: Transition from hospital to home

MacLean

Fauroux

2023

Paediatric Respiratory Reviews

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Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks

Cited by 7 publications

References 33 publications

A Nomogram for Predicting Extubation Failure in Preterm Infants with Gestational Age Less than 29 Weeks

A Nomogram for Predicting Extubation Failure in Preterm Infants with Gestational Age Less than 29 Weeks

Associations between unit workloads and outcomes of first extubation attempts in extremely premature infants below a gestational age of 26 weeks

Long-term non-invasive ventilation in children: Transition from hospital to home

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