Mechanical Ventilation and Successful Extubation Among Extremely Premature Infants : A population-based study using data from the Norwegian Neonatal Network

Abstract

Mechanical ventilation (MV) is crucial for the survival of nearly all extremely premature (EP) infants born before 26 weeks of gestational age (GA). However, prolonged MV can lead to adverse complications, and our understanding of the optimal extubation timing remains inadequate. This study aimed to investigate MV and extubation outcomes among EP infants born before 26 weeks of GA. It is a population-based study conducted between January 1, 2013, and December 31, 2018. Data from the Norwegian Neonatal Network, supplemented with information from patient medical records, were collected. The main findings of the study revealed variations in extubation success rates and the age at which successful extubation occurred based on GA at birth. The least mature infants had a higher likelihood of unsuccessful extubation. Among the entire population, being male and having an Apgar score below 5 at five minutes of age were associated with a longer duration of MV. The findings indicated that successful extubation odds were higher when the pre-oxygen requirement prior to the attempt was below 35%, when the infant had an Apgar score above 5 at five minutes of age, and when the infant was female. Additionally, high unit workload, weekday, and season showed no association with the number of days on MV before the first extubation attempt or the outcome of the attempt.