Download PDF
Am J Perinatol 2014; 31(12): 1063-1072
DOI: 10.1055/s-0034-1371702
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Early Extubation and Reintubation on the Incidence of Bronchopulmonary Dysplasia in Neonates

Jessica Berger
1   Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
,
Paulomi Mehta
1   Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
,
Emily Bucholz
1   Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
,
James Dziura
2   Yale Center for Analytical Sciences, Yale University School of Medicine, New Haven, Connecticut
,
Vineet Bhandari
1   Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
› Author Affiliations
Further Information

Publication History

13 September 2013

13 January 2014

Publication Date:
28 March 2014 (online)

Also available at
    Permissions and Reprints

Abstract

Objective The objective of this study was to assess rates of bronchopulmonary dysplasia (BPD) and BPD/death in infants first extubated between day of life (DOL) 1 to 3 versus 4 to 7, 8 + , and impact of reintubation.

Study Design We included infants with gestational age ≤ 28 weeks, birth weight ≤ 1,000 g, and intubation on DOL 1. Proportional hazards regression modeled time to BPD and BPD/death, adjusting for potential confounders.

Results Of 262 infants, 101 (38.55%), 41 (15.65%), and 120 (45.80%) were extubated between DOL 1 to 3, 4 to 7, and 8 + , respectively. Extubation between DOL 4 to 7 and DOL 1 to 3 was associated with an increased hazard of developing BPD (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.0–2.8; p < 0.05). Extubation on DOL 8+ was associated with a significantly increased hazard compared with extubation between DOL 1 to 3 (HR, 16.9; 95% CI, 10.5–27.1; p < 0.0001) and DOL 4 to 7 (HR, 10.0; 95% CI, 6.1–16.3; p < 0.0001). Similar results were noted with BPD/death. Reintubation did not affect BPD and BPD/death.

Conclusions Delaying extubation beyond the first 3 and 7 days was associated with an increased risk of BPD and BPD/death. Reintubation did not impact outcomes.

Keywords

neonate - invasive ventilation - NIPPV - BPD
 

  • References

  • 1 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (7) 1723-1729
    CrossrefPubMedGoogle Scholar
  • 2 Bhandari A, Bhandari V. Pitfalls, problems, and progress in bronchopulmonary dysplasia. Pediatrics 2009; 123 (6) 1562-1573
    CrossrefPubMedGoogle Scholar
  • 3 Fanaroff AA, Stoll BJ, Wright LL , et al; NICHD Neonatal Research Network. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007; 196 (2) e1-e8
    PubMedGoogle Scholar
  • 4 Stoll BJ, Hansen NI, Bell EF , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (3) 443-456
    CrossrefPubMedGoogle Scholar
  • 5 Walsh MC, Szefler S, Davis J , et al. Summary proceedings from the bronchopulmonary dysplasia group. Pediatrics 2006; 117 (3 Pt 2) S52-S56
    PubMedGoogle Scholar
  • 6 Parker RALD, Lindstrom DP, Cotton RB. Evidence from twin study implies possible genetic susceptibility to bronchopulmonary dysplasia. Semin Perinatol 1996; 20 (3) 206-209
    CrossrefPubMedGoogle Scholar
  • 7 Bhandari V, Gruen JR. The genetics of bronchopulmonary dysplasia. Semin Perinatol 2006; 30 (4) 185-191
    CrossrefPubMedGoogle Scholar
  • 8 Lavoie PM, Dubé MP. Genetics of bronchopulmonary dysplasia in the age of genomics. Curr Opin Pediatr 2010; 22 (2) 134-138
    CrossrefPubMedGoogle Scholar
  • 9 Bhandari A, Bhandari V. Pathogenesis, pathology and pathophysiology of pulmonary sequelae of bronchopulmonary dysplasia in premature infants. Front Biosci 2003; 8: e370-e380
    CrossrefPubMedGoogle Scholar
  • 10 Ali Z, Schmidt P, Dodd J, Jeppesen DL. Bronchopulmonary dysplasia: a review. Arch Gynecol Obstet 2013; 288 (2) 325-333
    CrossrefPubMedGoogle Scholar
  • 11 Gupta S, Sinha SK, Donn SM. Ventilatory management and bronchopulmonary dysplasia in preterm infants. Semin Fetal Neonatal Med 2009; 14 (6) 367-373
    CrossrefPubMedGoogle Scholar
  • 12 Shaffer TH, Alapati D, Greenspan JS, Wolfson MR. Neonatal non-invasive respiratory support: physiological implications. Pediatr Pulmonol 2012; 47 (9) 837-847
    CrossrefPubMedGoogle Scholar
  • 13 López ES, Rodríguez EM, Navarro CR, Sánchez-Luna M. Initial respiratory management in preterm infants and bronchopulmonary dysplasia. Clinics (Sao Paulo) 2011; 66 (5) 823-827
    CrossrefPubMedGoogle Scholar
  • 14 Gonzaga AD, Duque Figueira BB, Sousa JM, de Carvalho WB. Duration of mechanical ventilation and development of bronchopulmonary dysplasia [in Portuguese]. Rev Assoc Med Bras 2007; 53 (1) 64-67
    CrossrefPubMedGoogle Scholar
  • 15 Dumpa V, Northrup V, Bhandari V. Type and timing of ventilation in the first postnatal week is associated with bronchopulmonary dysplasia/death. Am J Perinatol 2011; 28 (4) 321-330
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Anonymous. An international classification of retinopathy of prematurity. Pediatrics 1984; 74 (1) 127-133
    CrossrefPubMedGoogle Scholar
  • 17 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4) 529-534
    CrossrefPubMedGoogle Scholar
  • 18 Bell MJTJ, Ternberg JL, Feigin RD , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (1) 1-7
    CrossrefPubMedGoogle Scholar
  • 19 Volpe JJ , ed. Intracranial hemorrhage: germinal matrix-intra-ventricular hemorrhage of the premature infant. In: Neurology of the Newborn. 4th ed. Philadelphia: WB Saunders; 2001: 435-447
    Google Scholar
  • 20 Levit O, Jiang Y, Bizzarro MJ , et al. The genetic susceptibility to respiratory distress syndrome. Pediatr Res 2009; 66 (6) 693-697
    CrossrefPubMedGoogle Scholar
  • 21 Bhandari V. Nasal intermittent positive pressure ventilation in the newborn: review of literature and evidence-based guidelines. J Perinatol 2010; 30 (8) 505-512
    CrossrefPubMedGoogle Scholar
  • 22 Fischer D, Weiss K, Buxmann H, Bremerich DH, Schloesser RL. Does short-term ventilation for semielective surgery influence the course of bronchopulmonary dysplasia in preterms?. Klin Padiatr 2009; 221 (5) 310-311
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Thomson MA, Yoder BA, Winter VT, Giavedoni L, Chang LY, Coalson JJ. Delayed extubation to nasal continuous positive airway pressure in the immature baboon model of bronchopulmonary dysplasia: lung clinical and pathological findings. Pediatrics 2006; 118 (5) 2038-2050
    CrossrefPubMedGoogle Scholar
  • 24 Booth C, Premkumar MH, Yannoulis A, Thomson M, Harrison M, Edwards AD. Sustainable use of continuous positive airway pressure in extremely preterm infants during the first week after delivery. Arch Dis Child Fetal Neonatal Ed 2006; 91 (6) F398-F402
    CrossrefPubMedGoogle Scholar
  • 25 Danan C, Durrmeyer X, Brochard L, Decobert F, Benani M, Dassieu G. A randomized trial of delayed extubation for the reduction of reintubation in extremely preterm infants. Pediatr Pulmonol 2008; 43 (2) 117-124
    CrossrefPubMedGoogle Scholar
  • 26 Robbins ME, Martin EM, Hitchner JC , et al. Early extubation attempts reduce length of stay in extremely premature infants even if re-intubation is necessary. EPAS 2011; 4532-4472
    PubMedGoogle Scholar
  • 27 Kavvadia V, Greenough A, Dimitriou G. Prediction of extubation failure in preterm neonates. Eur J Pediatr 2000; 159 (4) 227-231
    CrossrefPubMedGoogle Scholar
  • 28 Currie A, Patel DS, Rafferty GF, Greenough A. Prediction of extubation outcome in infants using the tension time index. Arch Dis Child Fetal Neonatal Ed 2011; 96 (4) F265-F269
    CrossrefPubMedGoogle Scholar
  • 29 Precup D, Robles-Rubio CA, Brown KA , et al. Prediction of extubation readiness in extreme preterm infants based on measures of cardiorespiratory variability. Conf Proc IEEE Engl Med Biol Soc 2012; 2012: 5630-5633
    PubMedGoogle Scholar
  • 30 Dimitriou G, Fouzas S, Vervenioti A, Tzifas S, Mantagos S. Prediction of extubation outcome in preterm infants by composite extubation indices. Pediatr Crit Care Med 2011; 12 (6) 242-249
    PubMedGoogle Scholar
  • 31 Kaczmarek J, Kamlin CO, Morley CJ, Davis PG, Sant'anna GM. Variability of respiratory parameters and extubation readiness in ventilated neonates. Arch Dis Child Fetal Neonatal Ed 2013; 98 (1) F70-F73
    CrossrefPubMedGoogle Scholar
  • 32 Kamlin CO, Davis PG, Argus B, Mills B, Morley CJ. A trial of spontaneous breathing to determine the readiness for extubation in very low birth weight infants: a prospective evaluation. Arch Dis Child Fetal Neonatal Ed 2008; 93 (4) F305-F306
    PubMedGoogle Scholar
  • 33 Parravicini E, Baccarelli A, Wung JT, Kolobow T, Lorenz JM. A comparison of a new, ultrathin-walled two-stage twin endotracheal tube and a conventional endotracheal tube in very premature infants with respiratory distress syndrome: a pilot study. Am J Perinatol 2007; 24 (2) 117-122
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Sant'Anna GM, Keszler M. Weaning infants from mechanical ventilation. Clin Perinatol 2012; 39 (3) 543-562
    CrossrefPubMedGoogle Scholar
  • 35 Axelin A, Ojajärvi U, Viitanen J, Lehtonen L. Promoting shorter duration of ventilator treatment decreases the number of painful procedures in preterm infants. Acta Paediatr 2009; 98 (11) 1751-1755
    CrossrefPubMedGoogle Scholar
  • 36 Chang BA, Huang Q, Quan J , et al. Early inflammation in the absence of overt infection in preterm neonates exposed to intensive care. Cytokine 2011; 56 (3) 621-626
    CrossrefPubMedGoogle Scholar
  • 37 Bhandari A, Bhandari V. Biomarkers in bronchopulmonary dysplasia. Paediatr Respir Rev 2013; 14 (3) 173-179
    PubMedGoogle Scholar
  • 38 Joshi P, Kakakios A, Jayasekera J, Isaacs D. A comparison of IL-2 levels in nasopharyngeal and endotracheal aspirates of babies with respiratory syncytial viral bronchiolitis. J Allergy Clin Immunol 1998; 102 (4 Pt 1) 618-620
    CrossrefPubMedGoogle Scholar
  • 39 Kulkarni A, Ehrenkranz RA, Bhandari V. Effect of introduction of synchronized nasal intermittent positive-pressure ventilation in a neonatal intensive care unit on bronchopulmonary dysplasia and growth in preterm infants. Am J Perinatol 2006; 23 (4) 233-240
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Hermeto F, Bottino MN, Vaillancourt K, Sant'Anna GM. Implementation of a respiratory therapist-driven protocol for neonatal ventilation: impact on the premature population. Pediatrics 2009; 123 (5) e907-e916
    CrossrefPubMedGoogle Scholar
  • 41 Johnson TJ, Patel AL, Jegier BJ, Engstrom JL, Meier PP. Cost of morbidities in very low birth weight infants. J Pediatr 2013; 162 (2) 243-249 , e1
    CrossrefPubMedGoogle Scholar
  • 42 Narang I. Review series: What goes around, comes around: childhood influences on later lung health? Long-term follow-up of infants with lung disease of prematurity. Chron Respir Dis 2010; 7 (4) 259-269
    CrossrefPubMedGoogle Scholar
  • 43 Gough A, Spence D, Linden M, Halliday HL, McGarvey LP. General and respiratory health outcomes in adult survivors of bronchopulmonary dysplasia: a systematic review. Chest 2012; 141 (6) 1554-1567
    CrossrefPubMedGoogle Scholar
  • 44 Bolton CE, Stocks J, Hennessy E , et al. The EPICure study: association between hemodynamics and lung function at 11 years after extremely preterm birth. J Pediatr 2012; 161 (4) 595-601 , e2
    CrossrefPubMedGoogle Scholar
  • 45 Short EJ, Klein NK, Lewis BA , et al. Cognitive and academic consequences of bronchopulmonary dysplasia and very low birth weight: 8-year-old outcomes. Pediatrics 2003; 112 (5) e359-e359
    CrossrefPubMedGoogle Scholar
  • 46 Short EJ, Kirchner HL, Asaad GR , et al. Developmental sequelae in preterm infants having a diagnosis of bronchopulmonary dysplasia: analysis using a severity-based classification system. Arch Pediatr Adolesc Med 2007; 161 (11) 1082-1087
    CrossrefPubMedGoogle Scholar