Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

Extubation failure in premature infants is common. A spontaneous breathing trial (SBT) was prospectively evaluated to determine timing of extubation. Compared with historical controls, infants were extubated at significantly higher ventilator rates and airway pressures using the SBT. No differences in rates of bronchopulmonary dysplasia or duration of ventilation were seen.

No abstract

Background: Very preterm infants can be treated with nasal continuous positive airway pressure (CPAP) from birth, but some fail. A rapid test, such as the stable microbubble test (SMT) on gastric aspirate, may identify those who can be managed successfully using CPAP. Objective: To determine if SMT can identify soon after birth, very preterm infants who may be successfully managed on CPAP alone. Methods: Stable microbubbles (diameter <15 µm) were counted in gastric aspirates taken <1 h of age from infants <30 weeks' gestation, who received CPAP from birth. Infants failed CPAP if intubated at <72 h of age. Clinicians were masked to SMT results. A receiver operating characteristic curve was generated to determine the relationship between number of microbubbles/mm² and subsequent intubation. Results: 68 infants of mean (SD) 28.1 (1.4) weeks' gestation received CPAP in the delivery room at a median (interquartile range) pressure 7 (6-8) cmH₂O and FiO₂ 0.25 (0.21-0.3). Gastric aspirates were taken at a median (interquartile range) age of 0.5 (0.3-0.6) hours. The best cut-off point for predicting CPAP success or failure was a SMT count of 8 microbubbles/mm². The area under the receiver operating characteristic curve was 0.8 (95% CI 0.7-0.9). A SMT count ≥8 microbubbles/mm² had a sensitivity of 53%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 60% for predicting CPAP success. Conclusion: Infants treated with CPAP from birth, who hadSMT counts ≥8 microbubbles/mm² on their gastric aspirate, did not fail CPAP.