Study of Risk Factors of Early Extubation Failure Among Very-Low-Birth-Weight Neonates: A Prospective Observational Study

Garvita Srivastava, Shalini Awasthi, Mala Kumar, Shakal Narayan Singh

Abstract

Background and Aim: Mechanical ventilation (MV) is necessary for very-low-birth-weight (VLBW) neonates with respiratory failure. We aim to find out the risk factors associated with early extubation failure (EF; within 72 h of extubation) in these neonates.

Materials and Methods: This prospective observational study was conducted in 60 VLBW neonates admitted to NICU in King George’s Medical University (Lucknow, Uttar Pradesh, India). The neonates were monitored for parameters such as respiratory distress score using Silverman Anderson score (SAS), blood gas, and other laboratory parameters such as hemoglobin, C-reactive protein, and blood culture during the periextubation period.

Results: Of the 60 neonates, extubation failed in 25 (41.7%) neonates. The risk factors associated with EF were shock (P = .002), use of vasopressors (P = .005), presence of complications (P = .032), S AS (P < .001), anemia (P = .017), culture-positive sepsis (P = .042), duration of MV (P = .006), postextubation FiO2 requirement (P < .001), and postextubation blood gas parameters (ie, pH, P < .001; PaCO2, P = .001; HCO3, P = .001; and SpO2/FiO2 ratio, P < .001). According to multivariate analysis, SAS (≥ 5, relative risk [RR], 5.23; 95% confidence interval [CI], 2.3–12; P < .001), and anemia (Hb ≤ 12; RR, 1.71; 95% CI, 0.96–3.06; P = .028) were significant risk factors. The mortality rate of neonates with EF was more (P = .002), and the length of NICU stay was also longer (ie, 27 ± 14 d vs 20 ± 12 d; P = .048) compared with neonates in whom extubation was successful.

Conclusion: Postextubation SAS of ≥ 5 and anemia were known to be the risk factors of EF. Neonates with EF had poor outcomes, with prolonged NICU stay and death, in some cases.