Early versus delayed extubation in extremely preterm neonates: a retrospective cohort study

ObjectiveTo evaluate clinical outcomes associated with extubation timing among extremely preterm neonates.Design/MethodsNeonates <26 weeks’ GA admitted to four tertiary neonatal centers were included if they met predetermined extubation criteria within first postnatal week and classified into early extubation (≤24 h; exposure group) and delayed extubation (>24 h; control group) after meeting extubation criteria. Patients with known severe IVH and/or significant PDA prior to meeting extubation criteria were excluded.ResultsOf 197 included infants, 75 were in exposure group. Survival without BPD (aOR 1.26; 95% CI 0.62–2.56; P = 0.52) and survival without severe IVH (aOR 1.98; 95% CI 0.93–4.23; P = 0.08) were not different, adjusted for GA, SNAP, number of surfactant doses and center.ConclusionsExtubation within 24 h of meeting extubation criteria in neonates <26 weeks’ GA was not associated with survival without BPD or survival without severe IVH. However, confounding by indication cannot be ruled out without a prospective trial.