Journal article
Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation
The Journal of pediatrics, Vol.189, pp.113-119.e2
10/2017
DOI: 10.1016/j.jpeds.2017.04.050
PMCID: PMC5657557
PMID: 28600154
Abstract
To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates.
This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation.
Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/ bronchopulmonary dysplasia (OR 3.27).
Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities.
ClinicalTrials.gov: NCT00233324.
Details
- Title: Subtitle
- Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation
- Creators
- Sanjay Chawla - Wayne State UniversityGirija Natarajan - Wayne State UniversitySeetha Shankaran - Wayne State UniversityBenjamin Carper - RTI InternationalLuc P. Brion - Southwestern Medical CenterMartin Keszler - Brown UniversityWaldemar A. Carlo - University of Alabama at BirminghamNamasivayam Ambalavanan - University of Alabama at BirminghamMarie G. Gantz - RTI InternationalAbhik Das - RTI InternationalNeil Finer - University of California San DiegoRonald N. Goldberg - Duke UniversityC. Michael Cotten - Duke UniversityRosemary D. Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentAlan H. Jobe - University of CincinnatiMichael S. Caplan - University of ChicagoRichard A. Polin - Columbia UniversityAbbot R. Laptook - Brown UniversityWilliam Oh - Brown UniversityAngelita M. Hensman - Brown UniversityDan Gingras - Brown UniversitySusan Barnett - Brown UniversitySarah Lillie - Brown UniversityKim Francis - Brown UniversityDawn Andrews - Brown UniversityKristen Angela - Brown UniversityMichele C. Walsh - Case Western Reserve UniversityAvroy A. Fanaroff - Case Western Reserve UniversityNancy S. Newman - Case Western Reserve UniversityBonnie S. Siner - Case Western Reserve UniversityKurt Schibler - University of CincinnatiEdward F. Donovan - University of CincinnatiVivek Narendran - University of CincinnatiKate Bridges - University of CincinnatiBarbara Alexander - University of CincinnatiCathy Grisby - University of CincinnatiMarcia Worley Mersmann - University of CincinnatiHolly L. Mincey - University of CincinnatiJody Hessling - University of CincinnatiKathy J. Auten - Duke University School of MedicineKimberly A. Fisher - Duke University School of MedicineKatherine A. Foy - Duke University School of MedicineGloria Siaw - Duke University School of MedicineBarbara J. Stoll - Emory UniversitySusie Buchter - Emory UniversityAnthony Piazza - Emory UniversityDavid P. Carlton - Emory UniversityEllen C. Hale - Emory UniversityStephanie Wilson Archer - Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBrenda B. Poindexter - Indiana University HospitalJames A. Lemons - Indiana University HospitalFaithe Hamer - Indiana University HospitalDianne E. Herron - Indiana University HospitalLucy C. Miller - Indiana University HospitalLeslie D. Wilson - Indiana University HospitalMary Anne Berberich - National Heart Lung and Blood InstituteCarol J. Blaisdell - National Heart Lung and Blood InstituteDorothy B. Gail - National Heart Lung and Blood InstituteJames P. Kiley - National Heart Lung and Blood InstituteW. Kenneth Poole - RTI InternationalMargaret Cunningham - RTI InternationalBetty K. Hastings - RTI InternationalAmanda R. Irene - RTI InternationalJeanette O'Donnell Auman - RTI InternationalCarolyn Petrie Huitema - RTI InternationalJames W. Pickett - RTI InternationalDennis Wallace - RTI InternationalKristin M. Zaterka-Baxter - RTI InternationalKrisa P. Van Meurs - Stanford UniversityDavid K. Stevenson - Stanford UniversityM. Bethany Ball - Stanford UniversityMelinda S. Proud - Stanford UniversityIvan D. Frantz - Tufts Medical CenterJohn M. Fiascone - Tufts Medical CenterAnne Furey - Tufts Medical CenterBrenda L. MacKinnon - Tufts Medical CenterEllen Nylen - Tufts Medical CenterMonica V. Collins - University of Alabama at BirminghamShirley S. Cosby - University of Alabama at BirminghamVivien A. Phillips - University of Alabama at BirminghamMaynard R. Rasmussen - University of California—San Diego, Medical Center and Sharp Mary Birch Hospital for WomenPaul R. Wozniak - University of California—San Diego, Medical Center and Sharp Mary Birch Hospital for WomenWade Rich - University of California—San Diego, Medical Center and Sharp Mary Birch Hospital for WomenKathy Arnell - University of California—San Diego, Medical Center and Sharp Mary Birch Hospital for WomenRenee Bridge - University of California—San Diego, Medical Center and Sharp Mary Birch Hospital for WomenClarence Demetrio - University of California—San Diego, Medical Center and Sharp Mary Birch Hospital for WomenEdward F. Bell - University of IowaJohn A. Widness - University of IowaJonathan M. Klein - University of IowaKaren J. Johnson - University of IowaShahnaz Duara - University of MiamiRuth Everett-Thomas - University of MiamiKristi L. Watterberg - University of New MexicoRobin K. Ohls - University of New MexicoJulie Rohr - University of New Mexico, Health Sciences CenterConra Backstrom Lacy - University of New MexicoDale L. Phelps - University of Rochester Medical CenterNirupama Laroia - University of Rochester Medical CenterLinda J. Reubens - University of Rochester Medical CenterErica Burnell - University of Rochester Medical CenterPablo J. Sánchez - The University of Texas Southwestern Medical CenterCharles R. Rosenfeld - The University of Texas Southwestern Medical CenterWalid A. Salhab - The University of Texas Southwestern Medical CenterJames Allen - The University of Texas Southwestern Medical CenterAlicia Guzman - The University of Texas Southwestern Medical CenterGaynelle Hensley - The University of Texas Southwestern Medical CenterMelissa H. Lepps - The University of Texas Southwestern Medical CenterMelissa Martin - The University of Texas Southwestern Medical CenterNancy A. Miller - The University of Texas Southwestern Medical CenterAraceli Solis - The University of Texas Southwestern Medical CenterDiana M. Vasil - The University of Texas Southwestern Medical CenterKerry Wilder - The University of Texas Southwestern Medical CenterKathleen A. Kennedy - The University of Texas Health Science Center at HoustonJon E. Tyson - The University of Texas Health Science Center at HoustonBrenda H. Morris - The University of Texas Health Science Center at HoustonBeverly Foley Harris - The University of Texas Health Science Center at HoustonAnna E. Lis - The University of Texas Health Science Center at HoustonSarah Martin - The University of Texas Health Science Center at HoustonGeorgia E. McDavid - The University of Texas Health Science Center at HoustonPatti L. Tate - The University of Texas Health Science Center at HoustonSharon L. Wright - The University of Texas Health Science Center at HoustonBradley A. Yoder - University of UtahRoger G. Faix - University of UtahJill Burnett - University of UtahJennifer J. Jensen - University of UtahKaren A. Osborne - University of UtahCynthia Spencer - University of UtahKimberlee Weaver-Lewis - University of UtahT. Michael O'Shea - Atrium Health Wake Forest BaptistNancy J. Peters - Atrium Health Wake Forest BaptistBeena G. Sood - Wayne State UniversityRebecca Bara - Wayne State UniversityElizabeth Billian - Wayne State UniversityMary Johnson - Wayne State UniversityRichard A. Ehrenkranz - Yale UniversityHarris C. Jacobs - Yale UniversityVineet Bhandari - Yale UniversityPat Cervone - Yale UniversityPatricia Gettner - Yale UniversityMonica Konstantino - Yale UniversityJoAnn Poulsen - Yale UniversityJanet Taft - Yale UniversityNational Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- The Journal of pediatrics, Vol.189, pp.113-119.e2
- DOI
- 10.1016/j.jpeds.2017.04.050
- PMID
- 28600154
- PMCID
- PMC5657557
- NLM abbreviation
- J Pediatr
- ISSN
- 0022-3476
- eISSN
- 1097-6833
- Publisher
- Elsevier Inc
- Grant note
- National Heart, Lung, and Blood Institute (http://dx.doi.org/10.13039/100000050) National Center for Research Resources (http://dx.doi.org/10.13039/100000097) National Center for Advancing Translational Sciences (http://dx.doi.org/10.13039/100006108) Eunice Kennedy Shriver National Institute of Child Health and Human Development (http://dx.doi.org/10.13039/100009633) The National Institutes of Health (http://dx.doi.org/10.13039/100000002)
- Language
- English
- Date published
- 10/2017
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984354049102771
Metrics
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