The following is a summary of “Age at First Extubation Attempt and Death or Respiratory Morbidities in Extremely Preterm Infants,” published in the JANUARY 2023 issue of Pediatrics by Shalish, et al.

For a study, researchers sought to investigate the timing of first extubation in extremely preterm infants and examine the relationship between age at first extubation, extubation outcome, and death or respiratory morbidities. 

The study included infants with birth weights of 1,250 g or less who were intubated within 24 hours of birth. The timing of first extubation was described, and age at extubation was categorized as early (within 7 days from birth) or late (days of life 8-35), and extubation outcome was classified as success or failure (reintubation within 7 days after extubation) to create four extubation groups: early success, early failure, late success, and late failure. Logistic regression analyses were performed to evaluate the associations between the four groups and death or bronchopulmonary dysplasia (BPD), BPD among survivors, and durations of respiratory support and oxygen therapy.

The study included 250 infants, of which 129 (52%) were extubated within 7 days, 93 (37%) between 8 and 35 days, and 28 (11%) beyond 35 days of life. The four extubation groups consisted of 93, 36, 59, and 34 infants with early success, early failure, late success, and late failure, respectively. The results showed that although early success was associated with the lowest rates of respiratory morbidities, early failure was not significantly associated with different respiratory outcomes compared with late success or late failure in unadjusted and adjusted analyses.

The study concluded that early extubation occurred in 52% of extremely preterm infants, and only early and successful extubation was associated with decreased respiratory morbidities. The study suggested the need for predictors capable of promptly identifying infants with a high likelihood of early extubation success or failure.