ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Neonatology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1555521
Risk Factors and Adverse Outcomes of Extubation Failure in Preterm Infants ≤32 Weeks with Neonatal Respiratory Distress Syndrome
Provisionally accepted
- 1Jiangxi Maternal and Child Health Hospital, Nanchang, China
- 2Department of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, Chongqing Municipality, China
- 3Children‘s Hospital of Chongqing Medical University, Chongqing, Chongqing Municipality, China
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Objective:Invasive mechanical ventilation (IMV) is a critical intervention for neonata l respiratory distress syndrome (NRDS). However, the high incidence of extubation fa ilure and its adverse impact on preterm outcomes make the optimal timing of extubati on a key clinical concern. This study aimed to identify risk factors for initial IMV ext ubation failure and analyze associated adverse outcomes in neonates ≤32 weeks' gesta tion with NRDS, providing evidence-based guidance for clinical decision-making.Me thod:A retrospective cohort study was conducted in the NICU of Jiangxi Maternal an d Child Health Hospital (January 2021-May 2024), including neonates ≤32 weeks wit h NRDS requiring IMV within 72h postnatal. Patients were stratified into success (n= 228) and failure (n=62) groups based on reintubation requirement within 72h post-ext ubation. Multivariable logistic regression and nomogram modeling were employed to analyze independent risk factors.Results:A total of 290 cases were included, with 228 in the successful extubation group and 62 in the failed extubation group, yielding an e xtubation failure rate of 21.4%.(1) Univariate analysis revealed that the extubation fai lure group had significantly lower gestational age, birth weight, weight at extubation, and initial serum albumin levels (p < 0.05) but higher day 1 fluid intake, fraction of in spired oxygen (FiO₂) before extubation, incidence of patent ductus arteriosus (PDA) > 1.5 mm, and grade III or higher intraventricular hemorrhage (IVH) (p < 0.05). Additio nally, maternal Ureaplasma urealyticum (UU) infection and placental abruption were more prevalent in the extubation failure group (p < 0.05).(2) Multivariate logistic regr ession identified maternal UU infection, placental abruption, lower weight at extubati on, higher FiO₂, grade III or higher IVH, and PDA >1.5 mm as independent risk facto rs for extubation failure (p < 0.05).
Keywords: Respiratory Distress Syndrome, Extubation failure, preterm infants, Intubation, mechanical ventilation
Received: 04 Jan 2025; Accepted: 18 Jun 2025.
Copyright: © 2025 朱, Wang, Liu, Li, Tang, Shi and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qingxiong Zhu, Jiangxi Maternal and Child Health Hospital, Nanchang, China
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