Risk factors for early extubation failure among very low birth weight neonates in a tertiary level neonatal unit of North India - a prospective observational study

Background- Premature births are on a rise. Mechanical ventilation (MV) is required by very low birth weight (VLBW) neonates with respiratory failure. Optimal extubation remains challenging, as approximately 30% of ventilated preterm infants fail extubation. The incidence and risk factors for extubation failure (EF) may vary from country to country. Methods- This prospective observational study was conducted among VLBW neonates to find the EF rate and risk factors. Results- Of the 60 enrolled neonates with a mean gestational age of 30.94±1.55 weeks and mean birth weight of 1198±201 grams, 25 (41.7%) failed extubation. The risk factors associated with EF were shock (0.002), use of vasopressor (0.005), presence of complications (pneumothorax, ventilator-associated pneumonia) (0.032), anemia (0.017), culture-positive sepsis (0.042), duration of MV (0.006), post-extubation FiO2 requirement (Conclusion- Forty-one percent of VLBW neonates failed extubation. Post extubation SAS of ≥ 5, anemia (hemoglobin less than 12 grams) were independent risk factors for EF. Neonates with EF had poor outcomes with more deaths and prolong NICU stay.