Predictive factors of successful extubation in extremely pre-term infants

Introduction Most of extremely preterm infants need mechanical ventilation support to maintain adequate oxygenation and ventilation. Moreover, this has led to improvement in survival. However, prolonged mechanical ventilation is involved in several complications and neonatal morbidities including bronchopulmonary dysplasia (BPD), neurodevelopmental impairment, infections and increased mortality. Currently, the timing of extubation is determined by clinical judgement observing numerous variables including birth weight, gestational age, Apgar score, ventilator settings, blood gas analysis, chest x-rays, breathing tests. This leads to the adoption of widely heterogeneous practices across neonatal intensive care units, due to of a lack of standardized guidelines. Previous studies have described the ability of clinical variables to determine extubation readiness in preterm infants. However, many of current predictors still have low overall accuracy and add little benefit in the identification of extubation failures. Thus, the aim of this study was to analyse elements involved in clinical decision addressed to predict success of extubation in extremely low birth preterm infants. Study design This was a retrospective single-center observational study. Infants with Birth weight (BW) <1000g or gestational age (GA) <28 weeks were included in the studied population. Extubation success was defined as survival without the need for reintubation for ≥72 hours. Results Of 270 infants, 80 were eligible. FiO2 levels have proven to be higher in failure group both pre- and post- extubation. In addition, infants with extubation failure underwent more days of mechanical ventilation (MV). Lastly, PROM would seem to be more associated with extubation success. Conclusions We have confirmed the relationship between the FiO2 levels and the outcome of the extubation. However, several elements that come into play in determining the outcome of the extubation remain unknown or uncertain. The clinical complexity of the extremely preterm infant contributes to this. The evaluation of the readiness of the extubation of the newborn remains a process that must take into account the entire clinical picture of the premature infant. Individual parameters play an important but not definitive role in this assessment. It is certainly necessary to deepen the knowledge of this topic. We are confident that prospective and multicentre studies can be the best tool to achieve this goal.