Al-Hathlol K, Bin Saleem N, Khawaji M, Al Saif S, Abdelhakim I, Al-Hathlol B, Bazbouz E, Al Anzi Q, Al-Essa A
J Neonatal Perinatal Med. 2017;10(2):163-169. doi: 10.3233/NPM-171647.
To identify the clinical outcomes and the potential predictive factors of early extubation failure (EEF) in very low birth weight (VLBW) infants.
A retrospective study of VLBW infants admitted to the neonatal intensive care unit (NICU) over fifteen years. Neonates were intubated and mechanically ventilated on the first day of life, and early extubated within the first 3 days. EEF was defined as the need for re-intubation within 3 days of the first extubation. A composite outcome of mortality or any major morbidity (grade 3-4 intraventricular hemorrhage or periventricular leukomalacia; stage 3-4 retinopathy of prematurity, moderate-severe bronchopulmonary dysplasia or stage 2-3 necrotizing enterocolitis) was assessed.
In total, 394 infants were extubated early. Of those, 347 (88%) had early extubation success (EES), whereas 47 (12%) had EEF. Incidence of the composite outcome was significantly higher in the EEF group than the EES group, even after adjusting for confounding factors. Logistic regression indicated that birth weight < 1000 g (p < 0.01), administration of≥2 doses of surfactant (p < 0.01) and administration of≥2 inotropic agents (p < 0.01) were all significantly associated with EEF. The area under the curve (AUC) for the combination of these three factors (AUC = 0.77) indicated significantly higher predictive value (p < 0.01) for EEF in VLBW infants, compared with individual factors (AUC = 0.59 for≥2 inotropic agents, AUC = 0.64 for birth weight≤1000 g and AUC = 0.66 for≥2 doses of surfactant).
EEF is associated with poor clinical outcomes in VLBW infants. The combination of birth weight and the requirement for surfactants and inotropic agents can predict EEF.
确定极低出生体重（VLBW）婴儿早期拔管失败（EEF）的临床结局及潜在预测因素。
对15年间入住新生儿重症监护病房（NICU）的VLBW婴儿进行回顾性研究。新生儿在出生首日接受插管及机械通气，并在出生后3天内进行早期拔管。EEF定义为首次拔管后3天内需要再次插管。评估死亡率或任何严重并发症（3-4级脑室内出血或脑室周围白质软化；3-4期早产儿视网膜病变、中度至重度支气管肺发育不良或2-3期坏死性小肠结肠炎）这一复合结局。
共有394例婴儿接受早期拔管。其中，347例（88%）早期拔管成功（EES），47例（12%）出现EEF。即使在调整混杂因素后，EEF组的复合结局发生率仍显著高于EES组。逻辑回归分析表明，出生体重<1000 g（p<0.01）、使用≥2剂表面活性剂（p<0.01）和使用≥2种血管活性药物（p<0.01）均与EEF显著相关。这三个因素联合的曲线下面积（AUC）（AUC = 0.77）显示，与单个因素相比，其对VLBW婴儿EEF的预测价值显著更高（使用≥2种血管活性药物时AUC = 0.59，出生体重≤1000 g时AUC = 0.64，使用≥2剂表面活性剂时AUC = 0.66）。
EEF与VLBW婴儿不良临床结局相关。出生体重以及表面活性剂和血管活性药物的使用需求联合起来可预测EEF。
