Outcomes of Infants Who Failed to Extubate despite Systemic Corticosteroids

Alain Cuna, Tamorah Lewis, Alexandra Oschman, Hong Ying Dai, Katie Brophy, Michael Norberg, Michael Nyp, William Truog

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective The objective of this study was to assess the outcomes of preterm infants who failed to extubate following initial treatment with steroids. Materials and Methods This is a retrospective cohort study of ventilator-dependent preterm infants treated with first course of systemic steroids to facilitate extubation. Outcomes of infants who successfully extubated were compared with infants who failed to extubate. Results In this study, 74 infants (mean gestation 25.4 ± 1.4 weeks and mean birth weight 764 ± 163 g) met inclusion criteria. Of these, 41 (55%) were successfully extubated and 33 (45%) were not. Baseline demographics were similar between the two groups. The primary outcome of severe bronchopulmonary dysplasia (BPD) or death at 36 weeks was higher among infants who failed to extubate (94 vs. 63%, p = 0.002). Severe BPD remained significantly higher even after adjustment for potential confounders (odds ratio: 12.2, 95% confidence interval: 2.1-70.5, p = 0.005). Extubation failure was also associated with substantially higher rate of tracheostomy (32 vs. 5%, p = 0.003) and gastrostomy tube placement (61 vs. 22%, p = 0.001), as well as longer days of hospitalization (179 ± 72 vs. 129 ± 44 days, p = 0.001) and mechanical ventilation (112 ± 89 vs. 52 ± 42 days, p < 0.001). Conclusion Failure to extubate after first course of systemic steroids for BPD is associated with poor prognostic implications.

Original languageEnglish (US)
Pages (from-to)1458-1463
Number of pages6
JournalAmerican Journal of Perinatology
Volume34
Issue number14
DOIs
StatePublished - Dec 1 2017

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Bronchopulmonary Dysplasia
Adrenal Cortex Hormones
Steroids
Premature Infants
Gastrostomy
Tracheostomy
Mechanical Ventilators
Artificial Respiration
Birth Weight
Hospitalization
Cohort Studies
Retrospective Studies
Odds Ratio
Demography
Confidence Intervals
Pregnancy
Therapeutics

Keywords

  • bronchopulmonary dysplasia
  • corticosteroids
  • extubation
  • outcome
  • prematurity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Outcomes of Infants Who Failed to Extubate despite Systemic Corticosteroids. / Cuna, Alain; Lewis, Tamorah; Oschman, Alexandra; Dai, Hong Ying; Brophy, Katie; Norberg, Michael; Nyp, Michael; Truog, William.

In: American Journal of Perinatology, Vol. 34, No. 14, 01.12.2017, p. 1458-1463.

Research output: Contribution to journalArticle

Cuna, A, Lewis, T, Oschman, A, Dai, HY, Brophy, K, Norberg, M, Nyp, M & Truog, W 2017, 'Outcomes of Infants Who Failed to Extubate despite Systemic Corticosteroids', American Journal of Perinatology, vol. 34, no. 14, pp. 1458-1463. https://doi.org/10.1055/s-0037-1604288
Cuna, Alain ; Lewis, Tamorah ; Oschman, Alexandra ; Dai, Hong Ying ; Brophy, Katie ; Norberg, Michael ; Nyp, Michael ; Truog, William. / Outcomes of Infants Who Failed to Extubate despite Systemic Corticosteroids. In: American Journal of Perinatology. 2017 ; Vol. 34, No. 14. pp. 1458-1463.
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abstract = "Objective The objective of this study was to assess the outcomes of preterm infants who failed to extubate following initial treatment with steroids. Materials and Methods This is a retrospective cohort study of ventilator-dependent preterm infants treated with first course of systemic steroids to facilitate extubation. Outcomes of infants who successfully extubated were compared with infants who failed to extubate. Results In this study, 74 infants (mean gestation 25.4 ± 1.4 weeks and mean birth weight 764 ± 163 g) met inclusion criteria. Of these, 41 (55{\%}) were successfully extubated and 33 (45{\%}) were not. Baseline demographics were similar between the two groups. The primary outcome of severe bronchopulmonary dysplasia (BPD) or death at 36 weeks was higher among infants who failed to extubate (94 vs. 63{\%}, p = 0.002). Severe BPD remained significantly higher even after adjustment for potential confounders (odds ratio: 12.2, 95{\%} confidence interval: 2.1-70.5, p = 0.005). Extubation failure was also associated with substantially higher rate of tracheostomy (32 vs. 5{\%}, p = 0.003) and gastrostomy tube placement (61 vs. 22{\%}, p = 0.001), as well as longer days of hospitalization (179 ± 72 vs. 129 ± 44 days, p = 0.001) and mechanical ventilation (112 ± 89 vs. 52 ± 42 days, p < 0.001). Conclusion Failure to extubate after first course of systemic steroids for BPD is associated with poor prognostic implications.",
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AU - Brophy, Katie

AU - Norberg, Michael

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AU - Truog, William

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N2 - Objective The objective of this study was to assess the outcomes of preterm infants who failed to extubate following initial treatment with steroids. Materials and Methods This is a retrospective cohort study of ventilator-dependent preterm infants treated with first course of systemic steroids to facilitate extubation. Outcomes of infants who successfully extubated were compared with infants who failed to extubate. Results In this study, 74 infants (mean gestation 25.4 ± 1.4 weeks and mean birth weight 764 ± 163 g) met inclusion criteria. Of these, 41 (55%) were successfully extubated and 33 (45%) were not. Baseline demographics were similar between the two groups. The primary outcome of severe bronchopulmonary dysplasia (BPD) or death at 36 weeks was higher among infants who failed to extubate (94 vs. 63%, p = 0.002). Severe BPD remained significantly higher even after adjustment for potential confounders (odds ratio: 12.2, 95% confidence interval: 2.1-70.5, p = 0.005). Extubation failure was also associated with substantially higher rate of tracheostomy (32 vs. 5%, p = 0.003) and gastrostomy tube placement (61 vs. 22%, p = 0.001), as well as longer days of hospitalization (179 ± 72 vs. 129 ± 44 days, p = 0.001) and mechanical ventilation (112 ± 89 vs. 52 ± 42 days, p < 0.001). Conclusion Failure to extubate after first course of systemic steroids for BPD is associated with poor prognostic implications.

AB - Objective The objective of this study was to assess the outcomes of preterm infants who failed to extubate following initial treatment with steroids. Materials and Methods This is a retrospective cohort study of ventilator-dependent preterm infants treated with first course of systemic steroids to facilitate extubation. Outcomes of infants who successfully extubated were compared with infants who failed to extubate. Results In this study, 74 infants (mean gestation 25.4 ± 1.4 weeks and mean birth weight 764 ± 163 g) met inclusion criteria. Of these, 41 (55%) were successfully extubated and 33 (45%) were not. Baseline demographics were similar between the two groups. The primary outcome of severe bronchopulmonary dysplasia (BPD) or death at 36 weeks was higher among infants who failed to extubate (94 vs. 63%, p = 0.002). Severe BPD remained significantly higher even after adjustment for potential confounders (odds ratio: 12.2, 95% confidence interval: 2.1-70.5, p = 0.005). Extubation failure was also associated with substantially higher rate of tracheostomy (32 vs. 5%, p = 0.003) and gastrostomy tube placement (61 vs. 22%, p = 0.001), as well as longer days of hospitalization (179 ± 72 vs. 129 ± 44 days, p = 0.001) and mechanical ventilation (112 ± 89 vs. 52 ± 42 days, p < 0.001). Conclusion Failure to extubate after first course of systemic steroids for BPD is associated with poor prognostic implications.

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