Early Extubation is Associated with a Reduced Risk of Developing Significant Bronchopulmonary Dysplasia - A Retrospective Audit

Background: As survival of preterm infants increases, greater attention is being paid to improving the quality of health in survivors. Unfortunately, despite advances in neonatal respiratory care, bronchopulmonary dysplasia (BPD) remains a significant cause of morbidity in the ex-preterm population. Consequently, there remains interest in developing strategies to reduce BPD incidence.

Objective: To identify clinical and demographic features associated with reduced incidence of BPD

Methods: This was a retrospective audit conducted between 2010-18 at a tertiary surgical neonatal unit at St George’s Hospital, London, UK. Data were extracted from a database of infants born at <32/40 gestation at St George`s Hospital. Information was collected on demography, clinical characteristics at birth, and respiratory clinical data. Significant BPD is defined as a need for supplemental oxygen or respiratory support at 36/40 corrected gestational age, in a baby born at <32/40 gestational age (as per National Neonatal Audit Programme definition).

Results: 396 infants were identified as having been born at <32/40 gestational age in the study period. 59% of the cohort met the definition for significant BPD. Incidence of significant BPD was seen to vary inversely with gestational age and birthweight. An association was seen between delayed extubation, and subsequent development of significant BPD. First extubation attempt beyond 24 hours was associated with an increased risk of developing BPD compared to when extubation was attempted within 24 hours (61% incidence vs. 18%, OR=7.1 [95%CI 4.5-11.4, p<0.0001); first extubation attempt beyond one week was associated with a further increased risk of BPD development, compared to extubation attempted within the first week (96% vs. 49%, OR=27 [95%CI 6.4-114.8, p<0.0001].

Conclusion: These data show an association between early extubation, and survival without development of significant BPD. Assessment of strategies to encourage early extubation may demonstrate a causative nature to this relationship, and reduce significant BPD incidence.