Wissam Shalish1, Lara Kanbar2, Lajos Kovacs3, Sanjay Chawla4, Martin Keszler5, Smita Rao1, Bogdan Panaitescu4, Alyse Laliberte5, Doina Precup6, Karen Brown7, Robert E Kearney2, Guilherme M Sant'Anna8. 1. Division of Neonatology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada. 2. Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada. 3. Department of Neonatology, Jewish General Hospital, Montreal, Quebec, Canada. 4. Division of Neonatal-Perinatal Medicine, Hutzel Women's Hospital, Wayne State University, Detroit, MI. 5. Division of Neonatology, Women and Infants Hospital of Rhode Island, Brown University, Providence, RI. 6. Department of Computer Science, McGill University, Montreal, Quebec, Canada. 7. Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada. 8. Division of Neonatology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada. Electronic address: guilherme.santanna@mcgill.ca.
Abstract
OBJECTIVE: To explore the relation between time to reintubation and death or bronchopulmonary dysplasia (BPD) in extremely preterm infants. STUDY DESIGN: This was a subanalysis from an ongoing multicenter observational study. Infants with birth weight ≤1250 g, requiring mechanical ventilation, and undergoing their first elective extubation were prospectively followed throughout hospitalization. Time to reintubation was defined as the time interval between first elective extubation and reintubation. Univariate and multivariate logistic regression analyses were performed to evaluate associations between time to reintubation, using different observation windows after extubation (24-hour intervals), and death/BPD (primary outcome) or BPD among survivors (secondary outcome). aORs were computed with and without the confounding effects of cumulative mechanical ventilation duration. RESULTS: Of 216 infants included for analysis, 103 (48%) were reintubated at least once after their first elective extubation. Reintubation was associated with lower gestational age/weight and greater morbidities compared with infants never reintubated. After adjusting for confounders, reintubation within observation windows ranging between 24 hours and 3 weeks postextubation was associated with increased odds of death/BPD (but not BPD among survivors), independent of the cumulative mechanical ventilation duration. Reintubation within 48 hours from extubation conferred higher risk-adjusted odds of death/BPD vs other observation windows. CONCLUSIONS: Although reintubation after elective extubation was independently associated with increased likelihood of death/BPD in extremely preterm infants, the greatest risk was attributable to reintubation within the first 48 hours postextubation. Prediction models capable of identifying the highest-risk infants may further improve outcomes.
OBJECTIVE: To explore the relation between time to reintubation and death or bronchopulmonary dysplasia (BPD) in extremely preterm infants. STUDY DESIGN: This was a subanalysis from an ongoing multicenter observational study. Infants with birth weight ≤1250 g, requiring mechanical ventilation, and undergoing their first elective extubation were prospectively followed throughout hospitalization. Time to reintubation was defined as the time interval between first elective extubation and reintubation. Univariate and multivariate logistic regression analyses were performed to evaluate associations between time to reintubation, using different observation windows after extubation (24-hour intervals), and death/BPD (primary outcome) or BPD among survivors (secondary outcome). aORs were computed with and without the confounding effects of cumulative mechanical ventilation duration. RESULTS: Of 216 infants included for analysis, 103 (48%) were reintubated at least once after their first elective extubation. Reintubation was associated with lower gestational age/weight and greater morbidities compared with infants never reintubated. After adjusting for confounders, reintubation within observation windows ranging between 24 hours and 3 weeks postextubation was associated with increased odds of death/BPD (but not BPD among survivors), independent of the cumulative mechanical ventilation duration. Reintubation within 48 hours from extubation conferred higher risk-adjusted odds of death/BPD vs other observation windows. CONCLUSIONS: Although reintubation after elective extubation was independently associated with increased likelihood of death/BPD in extremely preterm infants, the greatest risk was attributable to reintubation within the first 48 hours postextubation. Prediction models capable of identifying the highest-risk infants may further improve outcomes.
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