Early Extubation Success in Extreme Preterm Infants – Yorkshire ODN Experience

Presented at the Neonatal Society Spring Meeting 2019.

Authors: Aishin Lok, C Hudson, C Vasudevan, S Seal. Introduced by Dr Ela Chakkarapani

Institution(s)
Bradford Neonatal Unit

Introduction
Prolonged mechanical ventilation in the extremely preterm infant is associated with many morbidities and mortality. There are no measurements with satisfactory levels of sensitivity and specificity to predict the optimal moment for extubation. We aim to explore extubation practices in the extremely preterm /extremely low birth weight (ELBW) infants in 4 tertiary neonatal units across Yorkshire Neonatal Network and to assess composite outcome of mortality and predefined major morbidities.

Methods
A retrospective cohort study of extremely preterm infants (<27 weeks gestational age) or ELBW infants (birth weight <1000g) requiring mechanical ventilation at birth in 2016. Successful extubation is defined as not requiring reintubation for 72 hours post extubation.

Results
195 infant’s data were analysed. Wide variation of practices was found. Between 39% and 89% of infants were extubated in the first 72 hours of life. Earlier extubation is not found to have increase rate of major morbidities. It is not associated with higher rate of extubation success. Extubation success rate increases with GA (5% for 23 weeks GA vs 75% for 27 weeks GA). Successful extubation was associated with a higher birth weight and pre-extubation conditions such as higher pH and lower pre-extubation oxygen requirement.
Use of morphine pre-extubation, incomplete antenatal steroids and haemoglobin levels of less than 12 were positively associated with extubation failure. Infants who failed extubation had a higher mortality rate before discharge, retinopathy of prematurity, longer duration of respiratory support and hospitalisation.

Conclusions
Early extubation is feasible in the extremely preterm infants if pre-extubation conditions are optimised. Results of this study has helped to inform current neonatal extubation practice and warrant the development of regional guidelines for early extubation of the extreme preterm infants.

References: Acknowledgement: Leeds Neonatal Unit, Hull Neonatal Unit, Jessops Neonatal Unit.

Senior author supporting presentation on day of meeting: Dr C Vasudevan

Corresponding author e-mail address: aishin@doctors.org.uk