INTRODUCTION
Approximately 80% of extremely preterm (gestational age <28
weeks) infants receive mechanical ventilation (MV) to maintain
oxygenation and ventilation.1 A long cumulative
duration of MV in preterm infants hospitalized in the Neonatal Intensive
Care Unit (NICU) has been associated with higher rates of death and
various neonatal morbidities, including bronchopulmonary dysplasia
(BPD), upper airway injury, neurodevelopmental impairment, and
nosocomial infections.1-5 An early extubation may
reduce the risk of some of these complications.3, 4, 6However, about 25%-40% of elective extubations in preterm infants are
not successful.7-11 Unsuccessful extubations lead to a
substantial proportion of infants receiving multiple courses of MV
before first discharge from NICUs.12 Failed extubation
has been independently associated with an increased risk of mortality,
BPD, death or BPD, severe intracranial hemorrhage, longer
hospitalization, and longer duration of supplemental oxygen and
ventilator support.7, 11, 13-15 It is not known if the
higher rate of morbidities noted among infants who fail extubation,
compared to infants who are successfully extubated, are just
associations due to inherent differences among infants who fail or
succeed extubation and failure of extubation is just a marker of
immaturity and sickness; or whether failed extubation is independently
associated with a setback in the respiratory status of these infants.
The aim of this study was to evaluate the pre-extubation and post
reintubation respiratory status of infants who failed an extubation
attempt and to assess the time taken for these infants to achieve the
pre-extubation respiratory status after reintubation.