Zhu Chen, Wang Zhengli, Liu Kaizhen, Li Jiacheng, Tang Wenyan, Shi Yuan, Zhu Qingxiong
Department of Neonatology, Jiangxi Maternal and Child Health Hospital, Nanchang, China.
Department of Neonatology, Jiangxi Hospital Affiliated to Children's Hospital of Chongqing Medical University, Nanchang, China.
Front Pediatr. 2025 Jul 10;13:1555521. doi: 10.3389/fped.2025.1555521. eCollection 2025.
Invasive mechanical ventilation (IMV) is a critical intervention for neonatal respiratory distress syndrome (NRDS). However, the high incidence of extubation failure and its adverse impact on preterm outcomes make the optimal timing of extubation a key clinical concern. This study aimed to identify risk factors for initial IMV extubation failure and analyze associated adverse outcomes in neonates ≤32 weeks' gestation with NRDS, to provide evidence-based guidance for clinical decision-making.
A retrospective cohort study was conducted in the neonatal ICU (NICU) of Jiangxi Maternal and Child Health Hospital from January 2021 to May 2024, including neonates ≤32 weeks with NRDS who are required to receive IMV within 72 h postnatal. Patients were stratified into a success group ( = 228) and a failure ( = 62) group based on whether reintubation was required within 72 h post-extubation. Multivariable logistic regression and nomogram modeling were employed to analyze independent risk factors.
A total of 290 cases were included, comprising 228 in the successful extubation group and 62 in the failed extubation group, yielding an extubation failure rate of 21.4%. Univariate analysis revealed that the extubation failure group had significantly lower gestational age, birth weight, weight at extubation, and initial serum albumin levels ( < 0.05) but higher Day 1 fluid intake, fraction of inspired oxygen (FiO₂) before extubation, incidence of patent ductus arteriosus (PDA) >1.5 mm, and Grade 3 or higher intraventricular hemorrhage (IVH) ( < 0.05). Additionally, maternal (UU) infection and placental abruption were more prevalent in the extubation failure group ( < 0.05). Multivariate logistic regression identified maternal UU infection, placental abruption, lower weight at extubation, higher FiO₂, Grade 3 or higher IVH, and PDA >1.5 mm as independent risk factors for extubation failure ( < 0.05). A nomogram model incorporating these six factors demonstrated a sensitivity of 91% and a specificity of 52% for predicting extubation failure, with an area under the curve (AUC) of 0.77. The extubation failure group had higher incidences of atelectasis and bronchopulmonary dysplasia (BPD) and required longer IMV duration during hospitalization ( < 0.05).
Lower body weight at extubation, higher FiO₂, patent ductus arteriosus (PDA >1.5 mm), Grade 3 or higher intracranial hemorrhage, maternal infection, and placental abruption during pregnancy are independent risk factors for the failure of the first IMV extubation in neonates ≤32 weeks gestational age with NRDS. Extubation failure significantly increases the risk of atelectasis and BPD and prolongs the duration of invasive ventilatory support.
有创机械通气（IMV）是新生儿呼吸窘迫综合征（NRDS）的关键治疗手段。然而，拔管失败率高及其对早产结局的不利影响使得最佳拔管时机成为临床关注的重点。本研究旨在确定胎龄≤32周的NRDS新生儿初次IMV拔管失败的危险因素，并分析相关不良结局，为临床决策提供循证指导。
对2021年1月至2024年5月在江西省妇幼保健院新生儿重症监护病房（NICU）进行的一项回顾性队列研究，纳入产后72小时内需接受IMV的胎龄≤32周的NRDS新生儿。根据拔管后72小时内是否需要再次插管，将患者分为成功组（n = 228）和失败组（n = 62）。采用多变量逻辑回归和列线图建模分析独立危险因素。
共纳入290例病例，其中成功拔管组228例，失败组62例，拔管失败率为21.4%。单因素分析显示，拔管失败组的胎龄、出生体重、拔管时体重和初始血清白蛋白水平显著更低（P < 0.05），但第1天液体摄入量、拔管前吸入氧分数（FiO₂）、动脉导管未闭（PDA）>1.5 mm的发生率、3级或以上脑室内出血（IVH）更高（P < 0.05）。此外，拔管失败组孕妇解脲脲原体（UU）感染和胎盘早剥更为常见（P < 0.05）。多变量逻辑回归确定孕妇UU感染、胎盘早剥、拔管时体重较低、FiO₂较高、3级或以上IVH以及PDA >1.5 mm为拔管失败的独立危险因素（P < 0.05）。包含这六个因素的列线图模型预测拔管失败的敏感性为91%，特异性为52%，曲线下面积（AUC）为0.77。拔管失败组肺不张和支气管肺发育不良（BPD）的发生率更高，住院期间IMV持续时间更长（P < 0.05）。
胎龄≤32周的NRDS新生儿初次IMV拔管失败的独立危险因素包括拔管时体重较低、FiO₂较高、动脉导管未闭（PDA >1.5 mm）、3级或以上颅内出血、孕妇UU感染和孕期胎盘早剥。拔管失败显著增加肺不张和BPD的风险，并延长有创通气支持的持续时间。
