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Volume  3 (2024)
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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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