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VOLUME 3 , ISSUE 2 ( April-June, 2024 ) > List of Articles

ORIGINAL RESEARCH

Predictive Validity of a Neonatal Extubation Readiness Estimator in Preterm Neonates: A Retrospective, Pilot Analysis in an Inner-city Level-3 Neonatal Intensive Care Unit

Kulsajan S Bhatia, Bushra Tehreem, Faisal Siddiqui, Rickey H Taing, Colm Travers, Murali M Gopireddy, Sukhvinder Ranu

Keywords : Extubation, Extubation readiness estimator, Fraction of inspired oxygen, Mean airway pressure, Neonate, Pilot study, Respiratory severity score, Spontaneous breathing test trials, Ventilation, Very-low birth weight

Citation Information : Bhatia KS, Tehreem B, Siddiqui F, Taing RH, Travers C, Gopireddy MM, Ranu S. Predictive Validity of a Neonatal Extubation Readiness Estimator in Preterm Neonates: A Retrospective, Pilot Analysis in an Inner-city Level-3 Neonatal Intensive Care Unit. 2024; 3 (2):90-95.

DOI: 10.5005/jp-journals-11002-0092

License: CC BY-NC 4.0

Published Online: 21-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Successful extubation of very-low-birth-weight (VLBW) infants supported with assisted ventilation is associated with lower rates of morbidity and a shorter hospital stay. In this article, we assessed the performance of an extubation readiness estimator (ERE) in VLBW infants. Methods: We conducted a retrospective chart review including 64 intubated infants who were born at a gestational age of ≤30 weeks with a birth weight of ≤1500 gm. Our primary outcome assessed the performance of the ERE for the prediction of successful extubation using the area under the receiveroperating curve (AUROC). Results: Fifty-three neonates were extubated successfully. Eleven of these infants had to be intubated again within 5 days of the first attempt. Forty infants had ERE scores <80%; 6 needed reintubation. Among 24 infants with ERE scores ≥80%, 5 required reintubation. The performance of the ERE tool in our population was poor (AUROC = 0.49; sensitivity 36%, and specificity 54%). Conclusion: In our pilot study, an ERE-based approach to extubation of ventilated VLBW infants was deemed safe but could not accurately predict the transition to noninvasive ventilation. We are continuing to use clinical judgment-based extubation for now. Further studies are needed with more refined scales in larger cohorts.


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  1. Chawanpaiboon S, Vogel JP, Moller AB, et al. Global, regional, and national estimates of levels of preterm birth in 2014: A systematic review and modelling analysis. Lancet Glob Health 2019;7(1):e37–e46. DOI: 10.1016/S2214-109X(18)30451-0.
  2. Patel RM. Short- and long-term outcomes for extremely preterm infants. Am J Perinatol 2016;33(3):318–328. DOI: 10.1055/s-0035-1571202.
  3. Stoll BJ, Hansen NI, Bell EF, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993–2012. JAMA 2015;314(10):1039–1051. DOI: 10.1001/jama.2015.10244.
  4. Choi YB, Lee J, Park J, et al. Impact of prolonged Mechanical Ventilation in Very Low Birth Weight Infants: Results From a National Cohort Study. J Pediatr 2018;194:34.e3–39.e3. DOI: 10.1016/j.jpeds.2017.10.042.
  5. Escobar V, Soares DS, Kreling J, et al. Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: A pilot study. BMC Pediatr 2020;20(1):241. DOI: 10.1186/s12887-020-02129-2.
  6. Al-Mandari H, Shalish W, Dempsey E, et al. International survey on periextubation practices in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 2015;100(5):F428–F431. DOI: 10.1136/archdischild-2015-308549.
  7. Kamlin CO, Davis PG, Morley CJ. Predicting successful extubation of very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2006;91(3):F180–F183. DOI: 10.1136/adc.2005.081083.
  8. Chawla S, Natarajan G, Gelmini M, et al. Role of spontaneous breathing trial in predicting successful extubation in premature infants. Pediatr Pulmonol 2013;48(5):443–448. DOI: 10.1002/ppul.22623.
  9. Gupta D, Greenberg RG, Sharma A, et al. A predictive model for extubation readiness in extremely preterm infants. J Perinatol 2019;39(12):1663–1669. DOI: 10.1038/s41372-019-0475-x.
  10. Dryer RA, Salem A, Saroha V, et al. Evaluation and validation of a prediction model for extubation success in very preterm infants. J Perinatol 2022;42(12):1674–1679. DOI: 10.1038/s41372-022-01517-z.
  11. Shalish W, Latremouille S, Papenburg J, et al. Predictors of extubation readiness in preterm infants: A systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2019;104(1):F89–F97. DOI: 10.1136/archdischild-2017-313878.
  12. Teixeira RF, Carvalho ACA, de Araujo RD, et al. Spontaneous breathing trials in preterm infants: Systematic review and meta-analysis. Respir Care 2021;66(1):129–137. DOI: 10.4187/respcare.07928.
  13. Northway WH Jr, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med 1967;276(7):357–368. DOI: 10.1056/NEJM196702162760701.
  14. Shi Y, Muniraman H, Biniwale M, et al. A Review on non-invasive respiratory support for management of respiratory distress in extremely preterm infants. Front Pediatr 2020;8:270. DOI: 10.3389/fped.2020.00270.
  15. Abdel–Hady H, Nasef N, Shabaan AE, et al. Caffeine therapy in preterm infants. World J Clin Pediatr 2015;4(4):81–93. DOI: 10.5409/wjcp.v4.i4.81.
  16. McGoldrick E, Stewart F, Parker R, et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2020;12(12):CD004454. DOI: 10.1002/14651858.CD004454.pub4.
  17. Garib M, Salama N, Deraz S. Early versus late extubation after surfactant replacement therapy for respiratory distress syndrome. Egypt Pediatric Association Gaz 2015;63(1):1–5. DOI: 10.1016/j.epag.2015.02.003.
  18. Eckert GU, Filho JBF, Maia M, et al. A predictive score for retinopathy of prematurity in very low birth weight preterm infants. Eye (Lond) 2012;26(3):400–406. DOI: 10.1038/eye.2011.334.
  19. Goncalves E, Nasser LS, Martelli DR, et al. Incidence and risk factors for retinopathy of prematurity in a Brazilian reference service. Sao Paulo Med J 2014;132(2):85–91. DOI: 10.1590/1516-3180.2014.132 2544.
  20. Holmstrom G, Broberger U, Thomassen P. Neonatal risk factors for retinopathy of prematurity: A population-based study. Acta Ophthalmol Scand 1998;76(2):204–207. DOI: 10.1034/j.1600-0420.1998.760216.x.
  21. Jensen EA, Schmidt B. Epidemiology of bronchopulmonary dysplasia. Birth Defects Res A Clin Mol Teratol 2014;100(3):145–157. DOI: 10.1002/bdra.23235.
  22. Alonso AS, Diaz SP, Soto RS, et al. Epidemiology and risk factors for bronchopulmonary dysplasia in preterm infants born at or less than 32 weeks of gestation. An Pediatr (Engl Ed) 2022;96(3):242–251. DOI: 10.1016/j.anpede.2021.03.006.
  23. Russell RB, Green NS, Steiner CA, et al. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics 2007;120(1):e1–e9. DOI: 10.1542/peds.2006-2386.
  24. Johnson TJ, Patel AL, Jegier BJ, et al. Cost of morbidities in very low birth weight infants. J Pediatr 2013;162(2):243.e1–249.e1. DOI: 10.1016/j.jpeds.2012.07.013.
  25. Brix N, Sellmer A, Jensen MS, et al. Predictors for an unsuccessful INtubation-SURfactant-Extubation procedure: A cohort study. BMC Pediatr 2014;14:155. DOI: 10.1186/1471-2431-14-155.
  26. Robin X, Turck N, Hainard A, et al. pROC: An open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics 2011;12:77. DOI: 10.1186/1471-2105-12-77.
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