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Association between the respiratory severity score and extubation success in severe bronchopulmonary dysplasia

Journal of Perinatology (2025)Cite this article

Subjects

Abstract

Objective

Characteristics associated with extubation success (ES) in established grade 3 bronchopulmonary dysplasia (G3-BPD) are unknown. The respiratory severity score (RSS) is associated with extubation failure in younger preterm infants and adverse outcomes in established BPD. We evaluated the association between the RSS and ES in G3-BPD.

Study design

Retrospective observational study of infants diagnosed with G3-BPD undergoing their first extubation attempt after 36 weeks postmenstrual age (PMA). Bivariable and multivariable logistic regression models were used to determine the associations between RSS and ES while adjusting for confounding characteristics.

Results

Among 239 infants with G3-BPD undergoing an extubation attempt with a median RSS of 3.0, 142 (59%) were successful. A higher RSS was associated with lower odds of ES in adjusted analysis.

Conclusion

RSS is independently associated with ES in infants with established G3-BPD undergoing their first extubation attempt after 36 weeks PMA, with lower odds of success as RSS increases.

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Fig. 1: Estimated probability of extubation success in infants with grade 3 bronchopulmonary dysplasia with increasing respiratory severity score values.

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Data availability

The datasets generated during/or analyzed during the current study and the code used to analyze and manage the data are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Matthew Devine and Bolu Oluwalade in the Division of Neonatology for their data abstraction work.

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Authors and Affiliations

  1. Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Avery W. Zierk, Kathleen A. Gibbs, Timothy D. Nelin, Matthew Huber, Scott A. Lorch & Nicolas A. Bamat

  2. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Kathleen A. Gibbs, Timothy D. Nelin, Scott A. Lorch & Nicolas A. Bamat

  3. Leonard Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Timothy D. Nelin & Scott A. Lorch

Authors
  1. Avery W. Zierk
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  2. Kathleen A. Gibbs
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  3. Timothy D. Nelin
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  4. Matthew Huber
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  5. Scott A. Lorch
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  6. Nicolas A. Bamat
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Contributions

AZ, and NB conceptualized and designed the study, supervised, and collected data, designed the methodology with help from MH, interpreted the data, and analyzed results. MH carried out the analysis under supervision from NB. AZ wrote the initial manuscript draft, and reviewed and revised the manuscript throughout the submission process. KG, SL, TN helped conceptualize and revise the study. KG, SL, MH, TN reviewed and revised the manuscript throughout the submission process. NB reviewed and revised the initial draft and was involved with revisions throughout the submission process.

Corresponding author

Correspondence to Avery W. Zierk.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Data used for this study was approved for collection by the CHOP Institutional Review Board, #19-016420. Informed consent was not required. All methods were performed in accordance with relevant guidelines and regulations.

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Zierk, A.W., Gibbs, K.A., Nelin, T.D. et al. Association between the respiratory severity score and extubation success in severe bronchopulmonary dysplasia. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02396-w

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