Factors associated with successful extubation following the first course of systemic dexamethasone in ventilator‐dependent preterm infants with or at risk of developing bronchopulmonary dysplasia

Abstract

Objectives: We aimed to identify factors present at the start of an initial course of systemic dexamethasone that would be associated with successful extubation in mechanically ventilated neonates <30 weeks gestational age (GA) with or at risk of developing bronchopulmonary dysplasia (BPD).Methods: We studied a retrospective cohort of neonates (23 +0 −29 +6 weeks GA), with or at risk of developing BPD, prescribed their first course of systemic dexamethasone to aid in extubation from mechanical ventilation. The data collected only pertained to the first course of dexamethasone. Neonates given dexamethasone for airway edema were not included. The primary outcome of interest was successful extubation (i.e., extubated within 14 days of starting dexamethasone and remaining extubated for at least 7 days). Binary logistic regression was employed.Results: A total of 287 neonates were included. Each additional week of GA at birth led to a 1.53 increase in the odds of successful extubation (95% CI: 1.122-2.096, p < 0.01). Higher average fraction of inspired oxygen (FiO 2 ) requirements in the preceding 24 h resulted in a 0.94 decrease in the odds of successful extubation (p < 0.05) and higher mean airway pressure (MAP) resulted in 0.76 decrease in odds of successful extubation (p < 0.01).Conclusions: Mechanically ventilated neonates with or at risk of developing BPD, born at <30 week GA and initiated on dexamethasone to facilitate extubation, had a lower likelihood of successful extubation by Day 14 if they had younger GA at birth, and at the time of commencing steroids had higher MAPs and had higher oxygen requirements.

Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks

“…In several previous studies, low pre-extubation FiO 2 has been reported as predictive of extubation success 9 18 25. We suggest that a cut-off for pre-extubation FiO 2 at ≥0.35 is a clinically relevant predictor indicating a high risk for extubation failure.…”

Successful extubation in preterm infants

“…As both studies are comparable and an online calculator (http:// extubation.net/) exists, I think using this tool would be much easier, but I do agree with O'Connor et al 1 that we need to develop a prognostic scoring model for intubated preterm infants.…”

“…To the Editor, I read with great interest the article by O'Connor et al 1 describing factors that lower the likelihood of successful extubation by Day 14 in mechanically ventilated neonates with or at risk of developing bronchopulmonary dysplasia born at <30-week gestational age (GA).…”

“…A higher average fraction of inspired oxygen (FiO 2 ) requirements in the preceding 24 h resulted in a 0.94 decrease in the odds of successful extubation and higher mean airway pressure (MAP) resulted in a 0.76 decrease in odds of successful extubation. I have been using the probability of successful extubation calculator (http://extubation.net/), which incorporates the same factors as described by O'Connor et al 1 The calculator was described earlier by Gupta et al 2 They incorporated GA, MAP, and FiO 2 in the calculation, same as O'Connor et al 1 The only difference was the inclusion of the respiratory severity score (RSS), which is nothing but a product of MAP and FiO 2 [(RSS = mean airway pressure (cmH2O) × FiO 2 (0.21-1.00)]. Shalish et al 3 described the limitations of prior studies in predicting the probability of extubation in preterm infants.…”

“…Conner et al 1 used the MAP while Gupta et al 2 used the RSS, which incorporated the MAP in the formula (RSS = MAP × FiO 2 ).…”