Risk factors and clinical outcomes of extubation failure in very early preterm infants: a single-center cohort study

Background: Early extubation success (ES) in preterm infants may reduce various mechanical ventilation-associated complications; however, extubation failure (EF) can cause adverse short-term and long-term outcomes. Therefore, the present study aimed to identify the differences in risk factors and clinical outcomes between ES and EF in very early preterm infants. Methods: This retrospective study was conducted between January 2017 and December 2021. We enrolled premature infants born under the gestational age of 32 weeks who failed extubation even once in the EF group, and patients with similar gestational age and birth weight to the EF group and successful extubation at once were assigned to the ES group. EF was defined as the need for reintubation within 120 hours after extubation. Various variables were analyzed between the two groups. Results: EF rate in this study was 18.6% (24/129), and approximately 80% of EF patients required re-intubation within 90.17 h. In the ES group, there was less use of inotropes within 7 days of life (12(63.2%) vs. 22(91.7%), p=0.022), a lower respiratory severity score (RSS) at 1 and 4 weeks of age (1.72 vs. 2.5, p=0.026, 1.73 vs. 2.92, p=0.010), and a faster time to reach full feeding (18.7 vs. 29.7, p=0.020). There was a higher severity of BPD (3(15.8%) vs. 14(58.3%), p=0.018), a longer duration of oxygen supply (66.5 vs. 92.9, p=0.042), and higher corrected age at discharge (39.6 vs. 42.5, p=0.043) in the EF group. The cutoff value, sensitivity, and specificity of the RSS at 1 week of age were 1.98, 0.71, and 0.42, respectively, and the cutoff value, sensitivity, and specificity of RSS at 4 weeks of age were 2.22, 0.67, and 0.47, respectively Conclusions: EF can cause adverse short-term outcomes, such as a higher severity of BPD and a longer duration of hospital days. Therefore, extubation in very early preterm infants should be attempted carefully. The use of inotropes and proceeding feeding and RSS at 1 week of age can be helpful to predict successful extubation.