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Association of time of day and extubation success in very low birthweight infants: a multicenter cohort study

Journal of Perinatology volume 41, pages 2532–2536 (2021)Cite this article

Subjects

Abstract

Objective

To determine the association of overnight extubation (OE) with extubation success.

Study design

Retrospective cohort study in three NICUs from 2016 to 2020. Infants without congenital anomalies, less than 1500 grams at birth, who were ventilated and received an extubation attempt were included. Primary exposure was OE (7:00 pm–6:59 am) and outcome was extubation success defined as no mechanical ventilation for at least 7 days after extubation.

Results

A total of 76/379 (20%) infants received OE. Infants extubated during the daytime were older and had higher illness severity markers. Extubation success rates did not differ for overnight (57/76, 75%) versus daytime extubations (231/303, 76%) after adjusting for confounders (adjusted relative risk 0.95, 95% CI 0.82–1.11).

Conclusion

Though infants in our cohort undergoing daytime and OE were dissimilar, extubation success rates did not differ. Larger multicenter studies are needed to test our findings and identify markers of extubation readiness in preterm infants.

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Fig. 1: Timing of extubation attempts by hour of day.
Fig. 2: Kaplan–Meier plot of time to reintubation in infants by timing of extubation attempt.

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Funding

Use of the Research Electronic Data Capture program (REDCap) was supported by UL1 TR000445 from NCATS/NIH. Mrs. Guy was supported by the Vanderbilt-Meharry James P. Carter Scholars program. Dr. Hatch was supported by the Vanderbilt Department of Pediatrics Turner-Hazinski Research Award and the Gerber Foundation Research Award.

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Authors and Affiliations

  1. Meharry Medical College, Nashville, TN, USA

    Brittany Guy

  2. Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA

    Mary Eva Dye, Scott O. Guthrie & L. Dupree Hatch III

  3. Vanderbilt University School of Nursing, Nashville, TN, USA

    Mary Eva Dye

  4. Department of Pediatrics, Jackson-Madison County General Hospital, Jackson, TN, USA

    Laura Richards & Scott O. Guthrie

  5. Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA

    L. Dupree Hatch III

  6. Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA

    L. Dupree Hatch III

Authors
  1. Brittany Guy
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  2. Mary Eva Dye
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  3. Laura Richards
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  4. Scott O. Guthrie
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  5. L. Dupree Hatch III
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Contributions

BG and LDH conceptualized and designed the study and wrote the first draft of the manuscript. BG, MED, LR, and SOG performed and oversaw data collection. LDH designed and performed the statistical analyses. BG, MED, LR, SOG, and LDH reviewed and made significant edits to the manuscript and all authors agree with the final version as submitted.

Corresponding author

Correspondence to L. Dupree Hatch III.

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The authors declare no competing interests.

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Guy, B., Dye, M.E., Richards, L. et al. Association of time of day and extubation success in very low birthweight infants: a multicenter cohort study. J Perinatol 41, 2532–2536 (2021). https://doi.org/10.1038/s41372-021-01168-6

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