Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea.
BMC Pediatr. 2023 Jan 21;23(1):36. doi: 10.1186/s12887-023-03833-5.
Early extubation success (ES) in preterm infants may reduce various mechanical ventilation-associated complications; however, extubation failure (EF) can cause adverse short- and long-term outcomes. Therefore, the present study aimed to identify differences in risk factors and clinical outcomes between ES and EF in very early preterm infants.
This retrospective study was conducted between January 2017 and December 2021. Premature infants born at 32 weeks' gestational age in whom extubation had failed at least once were assigned to the EF group. Successfully extubated patients with a similar gestational age and birth weight as those in the EF group were assigned to the ES group. EF was defined as the need for re-intubation within 120 h of extubation. Various variables were compared between groups.
The EF rate in this study was 18.6% (24/129), and approximately 80% of patients with EF required re-intubation within 90.17 h. In the ES group, there was less use of inotropes within 7 days of life (12 [63.2%] vs. 22 [91.7%], p = 0.022), a lower respiratory severity score (RSS) at 1 and 4 weeks (1.72 vs. 2.5, p = 0.026; 1.73 vs. 2.92, p = 0.010), and a faster time to reach full feeding (18.7 vs. 29.7, p = 0.020). There was a higher severity of bronchopulmonary dysplasia BPD (3 [15.8%] vs. 14 [58.3%], p = 0.018), longer duration of oxygen supply (66.5 vs. 92.9, p = 0.042), and higher corrected age at discharge (39.6 vs. 42.5, p = 0.043) in the EF group. The cutoff value, sensitivity, and specificity of the respiratory severity score (RSS) at 1 week were 1.98, 0.71, and 0.42, respectively, and the cutoff value, sensitivity, and specificity of RSS at 4 weeks were 2.22, 0.67, and 0.47, respectively.
EF caused adverse short-term outcomes such as a higher BPD severity and longer hospital stay. Therefore, extubation in very early preterm infants should be carefully evaluated. Using inotropes, feeding, and RSS at 1 week of age can help predict extubation success.
早产儿早期拔管成功（ES）可能会降低各种与机械通气相关的并发症；然而，拔管失败（EF）会导致不良的短期和长期结局。因此，本研究旨在确定极早早产儿 ES 和 EF 之间的危险因素和临床结局差异。
这是一项回顾性研究，于 2017 年 1 月至 2021 年 12 月进行。胎龄为 32 周且至少有一次拔管失败的早产儿被分配到 EF 组。胎龄和出生体重与 EF 组相似且成功拔管的患者被分配到 ES 组。EF 定义为拔管后 120 小时内需要重新插管。比较两组之间的各种变量。
本研究的 EF 率为 18.6%（24/129），约 80%的 EF 患者需要在 90.17 小时内重新插管。在 ES 组中，生命 7 天内使用儿茶酚胺的比例较低（12 [63.2%] 比 22 [91.7%]，p=0.022），1 周和 4 周时的呼吸严重程度评分（RSS）较低（1.72 比 2.5，p=0.026；1.73 比 2.92，p=0.010），达到全肠内喂养的时间更快（18.7 比 29.7，p=0.020）。EF 组支气管肺发育不良 BPD 的严重程度更高（3 [15.8%] 比 14 [58.3%]，p=0.018），氧疗时间更长（66.5 比 92.9，p=0.042），校正胎龄出院时更高（39.6 比 42.5，p=0.043）。1 周时 RSS 的截断值、敏感性和特异性分别为 1.98、0.71 和 0.42，4 周时 RSS 的截断值、敏感性和特异性分别为 2.22、0.67 和 0.47。
EF 导致短期不良结局，如 BPD 严重程度增加和住院时间延长。因此，应对极早早产儿的拔管进行仔细评估。使用儿茶酚胺、喂养和 1 周时的 RSS 有助于预测拔管成功。
