The following is a summary of “Variability for Age at Successful Extubation in Infants with Congenital Diaphragmatic Hernia,” published in the FEBRUARY 2023 issue of Pediatrics by Porta, et al.

For a study, researchers sought to identify clinical factors associated with successful extubation in infants with congenital diaphragmatic hernia.

The Children’s Hospital’s Neonatal Database was used to identify infants with a congenital diaphragmatic hernia from 2017 to 2020 at 32 centers. The study assessed associations between clinical factors and age in days at the time of successful extubation. Unadjusted Kaplan-Meier and multivariable Cox proportional hazards ratio equations were utilized to estimate these associations, and observations occurred until 180 days after birth.

840 newborns met the eligibility requirements, with a median gestational age of 38 weeks and a birth weight of 3.0 kg. The average age at which extubation was accomplished was 15 days among survivors (n = 693) (interquartile range [IQR]: 8-29 days, 95th percentile: 71 days). The median age at death was 21 days for non-survivors (n = 147) (IQR: 11-39 days, 95th percentile: 110 days). Low birth weight, intrathoracic liver position, congenital heart disease, a lower 5-minute Apgar score, a lower pH at admission to the Children’s Hospitals Neonatal Database center, and the use of extracorporeal support were all independently associated with older age at successful extubation (adjusted hazards ratio: 0.22-15, P< .01). Many unsuccessful extubations were connected to tracheostomy.

The study’s findings suggested that infants who have not successfully extubated by approximately 3 months may be candidates for tracheostomy with chronic mechanical ventilation or palliation. The variability in the timing of successful extubation among centers supports the development of practice guidelines based on validated clinical criteria.

Reference: jpeds.com/article/S0022-3476(22)00853-8/fulltext