Factors associated with successful extubation following the use of
systemic dexamethasone in ventilator dependent extremely preterm infants
with bronchopulmonary dysplasia
Abstract
Objectives The aim of our study was to identify, in mechanically
ventilated neonates <30 weeks GA with clinical evidence of
bronchopulmonary dysplasia (BPD), factors likely to be predictive of a
first course of systemic dexamethasone leading to extubation within 14
days and remaining extubated for at least 7 days. Methods We studied a
retrospective cohort of neonates (23+0-29+6 weeks GA), with evidence of
BPD, prescribed their first course of systemic dexamethasone to aid in
extubation from mechanical ventilation. The data collected only
pertained to the first course of dexamethasone for any given neonate,
with the primary outcome of interest of successful extubation within 14
days (i.e., extubated within 14 days of starting dexamethasone and
remaining extubated for at least seven days). Binary logistic regression
was employed. Results A total of 287 neonates were included. Each
additional week of GA at birth led to a 1.53 increase in the odds of
successful extubation (95% CI 1.122-2.096, p<0.01). Higher
average fraction of inspired oxygen (FiO2) requirements in the preceding
24 hours resulted in a 0.94 decrease in the odds of successful
extubation (p<0.05) and higher mean airway pressure (MAP)
resulted in 0.76 decrease in odds of successful extubation
(p<0.01). Conclusions Mechanically ventilated neonates born at
<30 week GA, with evidence of BPD requiring dexamethasone to
facilitate extubation, had a lower likelihood of successful extubation
by day 14 if at the time of commencing steroids they were less mature at
birth, had higher MAPs and higher oxygen requirements.