Sanjay Chawla1, Girija Natarajan2, Seetha Shankaran2, Benjamin Carper3, Luc P Brion4, Martin Keszler5, Waldemar A Carlo6, Namasivayam Ambalavanan6, Marie G Gantz3, Abhik Das7, Neil Finer8, Ronald N Goldberg9, C Michael Cotten9, Rosemary D Higgins10. 1. Department of Pediatrics, Wayne State University, Detroit, MI. Electronic address: schawla@dmc.org. 2. Department of Pediatrics, Wayne State University, Detroit, MI. 3. Social, Statistical and Environmental Sciences Unit, Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC. 4. Department of Pediatrics, University of Southwestern Medical Center, Dallas, TX. 5. Department of Pediatrics, Women and Infant Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI. 6. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL. 7. Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, MD. 8. Department of Pediatrics, UC San Diego Medical Center, UC San Diego School of Medicine, San Diego, CA. 9. Department of Pediatrics, Duke University School of Medicine, Durham, NC. 10. Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Abstract
OBJECTIVES: To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. STUDY DESIGN: 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. RESULTS: 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). CONCLUSIONS: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. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00233324.
RCT Entities:
OBJECTIVES: To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. STUDY DESIGN: 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. RESULTS: 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). CONCLUSIONS: 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. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00233324.
Authors: Fernanda Hermeto; Bianca M R Martins; José R M Ramos; Carlos A Bhering; Guilherme M Sant'Anna Journal: J Pediatr (Rio J) Date: 2009-08-18 Impact factor: 2.197
Authors: Neil N Finer; Waldemar A Carlo; Michele C Walsh; Wade Rich; Marie G Gantz; Abbot R Laptook; Bradley A Yoder; Roger G Faix; Abhik Das; W Kenneth Poole; Edward F Donovan; Nancy S Newman; Namasivayam Ambalavanan; Ivan D Frantz; Susie Buchter; Pablo J Sánchez; Kathleen A Kennedy; Nirupama Laroia; Brenda B Poindexter; C Michael Cotten; Krisa P Van Meurs; Shahnaz Duara; Vivek Narendran; Beena G Sood; T Michael O'Shea; Edward F Bell; Vineet Bhandari; Kristi L Watterberg; Rosemary D Higgins Journal: N Engl J Med Date: 2010-05-16 Impact factor: 91.245
Authors: Lara J Kanbar; Wissam Shalish; Charles C Onu; Samantha Latremouille; Lajos Kovacs; Martin Keszler; Sanjay Chawla; Karen A Brown; Doina Precup; Robert E Kearney; Guilherme M Sant'Anna Journal: Pediatr Res Date: 2022-07-29 Impact factor: 3.953
Authors: Emma E Williams; Fahad M S Arattu Thodika; Imogen Chappelow; Nicole Chapman-Hatchett; Theodore Dassios; Anne Greenough Journal: Pediatr Res Date: 2022-05-06 Impact factor: 3.953
Authors: Fernando R Moya; Jan Mazela; Paul M Shore; Steven G Simonson; Robert Segal; Phillip D Simmons; Timothy J Gregory; Carlos G Guardia; Judy R Varga; Neil N Finer Journal: BMC Pediatr Date: 2019-05-11 Impact factor: 2.125