Respiratory Support Adequacy for Very Low Birth Weight Infants Post Extubation

Objective: Study the predictors of extubation trial failure, for very low birth weight infant.

Methods: Retrospective review and analysis of very low birth weight infants, intubated in neonatal intensive care unit - Tawam Hospital, 2011 till 2018.

Results: GA (21+4- 26+6) weeks, extubation failure associates Male gender, FIO2 level >0.30, and high PCO₂ level above 55 mmhg post extubation, Ground glass appearance on chest XR at trial, large PDA, low and advanced grades IVH. Success associates FIO₂ level <(0.25) before extubation, post extubation PEEP level (6-7) cm water.

GA (27- 29+6) weeks, failure associates FIO₂ level >0.30, and low PH level (6.9 - 7.24) post extubation, advanced grade IVH. Success associates single antenatal steroid dose, FIO₂ level (0.21) before extubation, post extubation PEEP level range (6-7) cm.

GA (30- 32) weeks, failure associates FIO₂ level >0.30, low PH level (6.9 - 7.24), and low PO2 (20-40) mmhg post extubation, large PDA. Success associates mother’s Pre-labor rupture of membranes, adequately sized, waiting until FIO₂ requirement level is < (0.25), and IT >0.38 sec before extubation.

Surfactant dose not determine extubation trial results for GA (21+4- 23+6). Success associates 2 doses for GA (24- 26+6) weeks, single dose for GA (27- 29+6) weeks, and all 1st, 2nd and 3rd doses for GA (30-32) weeks.

Low phosphorus level associate’s failure for GA (24- 26+6, 27- 29+6).

Conclusion: Predictors of extubation trial failure vary among GA groups, and may guide physician to predict the result of extubation trial and reduce exposure to failure. Optimizing documentation and follow up research studies on larger sample size, are recommended to analyze secondary predictors.

Keywords: ELBW; Extubation failure; Risk factor; Bronchopulmonary dysplasia; Ventilation; NAVA