| Background and objectivesInvasive mechanical ventilation is an important life support technique in the neonatal intensive care unit(NICU).Extubation failure in neonates is relatively common,with approximately 30%of very low birth weight infants(VLBW)and 60%to 70%of extremely low birth weight infants(ELBW)experiencing extubation failure during hospitalization,requiring reintubation at least once.Currently,there is a lack of a uniform definition of extubation failure in neonates.A meta-analysis found that the observation window for defining extubation failure in neonates ranged from 12 h to 7 days after initial extubation,with reintubation within 72 h being the most commonly used.At present,there is little evidence about the correlation between extubation failure under different definitions and neonatal prognosis,which is worth further exploration.Bronchopulmonary dysplasia(BPD)is the most common chronic pulmonary disease in preterm infants,which can increase mortality and odds of long-term complications in multiple systems,including the respiratory,neurological and circulatory systems.Prolonged mechanical ventilation is associated with an increased risk of BPD,and extubation failure can prolong the duration of mechanical ventilation.Whether the extubation failure on its own increases the risk of BPD and/or death,the recent studiers showed inconsistent results.One of the main reasons was that the observation windows to define extubation failure differed among studies.Therefore,by analyzing the time and causes of reintubations of VLBW or ELBW infants,we sought to explore the associations between time to reintubation and the outcome of moderate-to-severe BPD and/or death in a retrospective cohort study.MethodsThis article included 244 VLBW or ELBW infants hospitalized in the neonatal department of our hospital from January 2014 to December 2021,collecting general information,perinatal conditions,treatment after admission,initial extubation and reintubation data,and complications etc.Infants were divided into BPD/death group and control group,according to the development of moderate-to-severe BPD or/and death at discharge.The time and causes of reintubations were analyzed to explore the associations between time to reintubation and moderate-to-severe BPD and/or death.Statistical analysis was performed using SPSS 22.0 software.Results1.Analysis of reintubations during hospitalization1.1 Yearly trend of reintubation rate:From 2014 to 2021,the reintubation rate of VLBW or ELBW infants in the first ward of neonatal department of our hospital showed a downward trend year by year,and the difference was statistically significant(p=0.013).1.2 Reintubation rate of different gestational age and birth weight:The reintubation rate of infants with a gestational age of<28 W was 66.7%,and with a gestational age of 28-31+6 W was 31.7%,with a statistically significant difference(p<0.001).The reintubation rate of VLBW infants was 31.6%,and for ELBW infants was 54.3%,with a statistically significant difference(p=0.001).The lower the gestational age and birth weight,the higher the reintubation rate during hospitalization.1.3 Reintubation rates in different observation windows:Of the 244 infants included,93(38.1%)were reintubated during hospitalization.As the observation windows increased,the odds of extubation failure became lower gradually.1.4 Reintubation rate in different time periods:Among the 93 reintubated infants,33 cases(35.5%)were reintubated within 24 h postextubation and 18 cases(19.4%)were reintubated between 24 h and 48 h after the initial extubation.Extubation failure occurred mainly in the time periods of 0 to 24 h and 24 to 48 h after initial extubation.1.5 Reasons of reintubation during hospitalization:Of the 93 reintubated infants,69(74.2%)were respiratory reintubations and 24(25.8%)were non-respiratory reintubations.The main reasons of reintubation were respiratory causes including apnea(39.8%),increased respiratory work(44.0%),and respiratory acidosis(37.6%).2.Analysis of the associations between time to reintubation and moderate-to-severe BPD and/or death2.1 Univariate analysis of the occurrence of moderate-to-severe BPD/death:Out of 244 infnats,57(23.4%)who died and/or developed moderate-to-severe BPD were included in the moderate-to-severe BPD/death group,and the other 187(76.6%)were included in the control group.Univariate analysis showed that gestational age,birth weight,5-minute Apgar,PH of pre-extubation,and corrected gestational age at extubation were lower in the moderate-to-severe BPD/death group than in the control group,and propotions of postnatal intravenous corticosteroids use,small for gestational age,PS≥2 times,number of transfusions,total MV days,number of MVs,and PaCO2 before extubation were higher than in the control group.Moreover,the rates of complications including pneumonia,confirmed sepsis,NEC,severe NEC and ROP in the moderate-to-severe BPD/death group were also higher than those in the control group,with statistically significant differences(p<0.05).2.2 Multivariate analysis of moderate-to-severe BPD/death:Logistic regression analysis showed that reintubation within 48 h or 72 h after initial extubation,prolonged total mechanical ventilation days,low birth weight,and pneumonia were independent risk factors of the development of moderate-to-severe BPD/death[reintubation within 48 h:OR,3.778,95%CI(1.293,11.039);72 h:OR,3.268,95%CI(1.127,9.471)],with a statistically significant difference(p<0.05).The earlier the extubation failure occurred,the greater the odds of moderate to severe BPD/death,and reintubation after 72 h postextubation may not affect the risk of moderate to severe BPD/death.2.3 Reintubations in infants with moderate-to-severe BPD and death:Of the 35 infants with moderate-to-severe BPD,25(80.6%)required reintubation at least once during hospitalization and 16(45.3%)were reintubated within 72 h after initial extubation.Of the 31 infants died before discharge,25(80.6%)required reintubation during hospitalization and 19(61.3%)were reintubated within 72 h after first extubation.A majority of infants with moderate-to-severe BPD and/or death had extubation failure at least once during hospitalization,and reintubation occurred mainly within 72 h of initial extubation.2.4 Multivariate analysis of moderate-to-severe BPD and death:Logistic regression analysis showed that extubation failure within different observation windows was not an independent risk factor of moderate-to-severe BPD,and the difference was not statistically significant(p>0.05).Extubation failure within 48 h or 72 h after initial extubation was an independent risk factor for the occurrence of death[48 h:OR,4.734,95%CI(1.158,19.354);72 h:OR,4.321,95%CI(1.081,17.277)],with statistically significant differences(p<0.05).The earlier the extubation failure occurred,the greater the risk of infant deaths.Conclusion1.The lower the gestational age and birth weight,the higher the rates of extubation failure.Extubation failure of ELBW/VLBW infants mainly occurred within 48 h after initial extubation.Apneas,respiratory distress,and respiratory acidosis were the main reasons of reintubation.2.Extubation failure within 72 h after initial extubation independently modulated the risk of moderate to severe BPD/death and death in ELBW/VLBW infants,but not moderate to severe BPD.The earlier the reintubation occurred,the higher the risk of moderate to severe BPD/death and death in ELBW/VLBW infants. |
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