Robbins M, Trittmann J, Martin E, Reber Kristina M, Nelin L, Shepherd E
Division of Neonatology, Department of Pediatrics, The Ohio State University, OH, USA.
Center for Perinatal Research, Research Institute at Nationwide Children's Hospital, OH, USA.
J Neonatal Perinatal Med. 2015;8(2):91-7. doi: 10.3233/NPM-15814061.
Prolonged mechanical ventilation in the extremely premature infant is associated with the development of bronchopulmonary dysplasia (BPD). Clinically, the decision to extubate the extremely low birth weight (ELBW) infant can be difficult. There is continued debate regarding whether it is better for an ELBW infant to remain on the ventilator or to extubate to nasal constant positive airway pressure (nCPAP). It has also been argued that repeated intubations may be detrimental to ELBW infants. We tested the hypothesis that earlier extubation attempts would decrease length of hospital stay and BPD.
A database maintained on infants born at <27 completed weeks gestation admitted to our all referral NICU for a 36 month period was queried (n = 224).
Day of life (DOL) of the first extubation attempt was inversely correlated with birth weight (p < 0.001) and gestational age (p < 0.01). The DOL of the 1st extubation attempt correlated with the need for re-intubation (p < 0.001), but not with mortality (p = 0.27). In survivors, earlier DOL of 1st extubation attempt was associated with shorter LOS (p < 0.001). Earlier DOL of the 1st extubation attempt was associated with less need for supplemental oxygen (p < 0.001) at 36 weeks CGA, while re-intubation was not (p = 0.50).
In our cohort of extremely premature infants, the earlier the first extubation attempt the sooner the patient was discharged home and the less likely to develop BPD. Our study suggests that extubation should not be delayed in extremely premature infants due to fears of need for re-intubation.
极早产儿长时间机械通气与支气管肺发育不良（BPD）的发生有关。临床上，决定对极低出生体重（ELBW）婴儿进行拔管可能很困难。关于ELBW婴儿继续使用呼吸机还是拔管至鼻持续气道正压通气（nCPAP）哪种更好，一直存在争议。也有人认为反复插管可能对ELBW婴儿有害。我们检验了早期拔管尝试会减少住院时间和BPD发生率这一假设。
查询了我们全转诊新生儿重症监护病房（NICU）在36个月期间收治的孕周<27周的婴儿的数据库（n = 224）。
首次拔管尝试的日龄（DOL）与出生体重呈负相关（p < 0.001），与胎龄呈负相关（p < 0.01）。首次拔管尝试的DOL与再次插管的需求相关（p < 0.001），但与死亡率无关（p = 0.27）。在存活者中，首次拔管尝试的DOL越早，住院时间越短（p < 0.001）。首次拔管尝试的DOL越早，在矫正胎龄36周时对补充氧气的需求越少（p < 0.001），而再次插管则不然（p = 0.50）。
在我们的极早产儿队列中，首次拔管尝试越早，患者出院回家就越早，发生BPD的可能性就越小。我们的研究表明，不应因担心需要再次插管而延迟对极早产儿的拔管。
