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1/2017
vol. 92 streszczenie artykułu:
Artykuł oryginalny
Risk factors associated with extubation failure in preterm infants with very low birth weight
Anna Menshykova
,
Dmytro Dobryanskyy
PEDIATRIA POLSKA 92 (2017) 22-27
Data publikacji online: 2018/03/07
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Repeated endotracheal intubation is associated with complications and additional risks for a preterm infant. The aim of this study was to determine the risk factors related to extubation failure (EF) in preterm newborns. Materials and methods Ninety two very preterm infants with respiratory distress syndrome (RDS), birth weight of <1500 g, mechanically ventilated, and extubated before the 7th day of life were enrolled into prospective study. Following extubation, noninvasive respiratory support was provided. Infants who required reintubation within 72 h after primary extubation constituted the main group (n = 27) while those, whose primary extubation was successful, were included into the comparison group (n = 65). Results Infants from the main group differed by lower antenatal steroid administration rate, higher incidence of intraventricular hemorrhage, severe RDS, arterial hypotension, metabolic acidosis, and pulmonary bleeding, as well as by the need in higher initial mechanical ventilation settings. According to logistic regression analysis the risk of EF was significantly associated with severe RDS (OR – 3.82; 95% CI: 1.21–12.02), arterial hypotension (OR – 24.05; 95% CI: 1.99–290.48) or metabolic acidosis (OR – 4.62; 95% CI: 1.41–15.16) in the first 3 days of life. Antenatal steroid prophylaxis considerably decreased the probability of EF (OR – 0.2; 95% CI: 0.063–0.68). Conclusions The risk of reintubation after primary extubation is determined by severe RDS, arterial hypotension or metabolic acidosis during the first 3 days of life. Antenatal steroid prophylaxis substantially decreases this risk. The method of non-invasive respiratory support following primary extubation does not influence the reintubation risk. |