Extubation failure in very preterm infants: associations with respiratory outcomes in a nine-year cohort study.
6 affiliations
- 1Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia. [email protected].
- 2King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia. [email protected].
- 3King Saud Bin Abdulaziz University for Medical Sciences, Riyadh, Saudi Arabia. [email protected].
- 4Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
- 5King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
- 6King Saud Bin Abdulaziz University for Medical Sciences, Riyadh, Saudi Arabia.
Abstract
Background
Extubation failure is a common event in very preterm infants and has been associated with adverse respiratory and clinical outcomes. However, it remains unclear whether extubation failure independently contributes to subsequent morbidity or primarily reflects underlying respiratory disease severity.Methods
We conducted a retrospective cohort study of ventilated infants born at less than 32 weeks of gestation in a tertiary neonatal intensive care unit over a 9-year period. Infants who underwent at least one planned extubation attempt were included. Extubation failure was defined as the need for reintubation within 72 h of planned extubation. Multivariate analyses were performed to identify independent predictors and to evaluate associations with moderate-to-severe bronchopulmonary dysplasia (BPD), duration of invasive ventilation, length of hospital stay, and infection-related morbidity.Results
A total of 877 infants were included, of whom 89 (10.1%) experienced extubation failure. The incidence demonstrated a strong gestational age gradient, decreasing from 22.5% at less than 26 weeks to 4.9% at 30-31 + 6 weeks (p < 0.001). In multivariate analysis (n = 858), gestational age remained the only independent predictor of extubation failure among the variables available for analysis (adjusted OR 0.78 per week, 95% CI 0.65-0.94; p = 0.007), while birth weight, Apgar score, antenatal steroid exposure, surfactant requirement, early pulmonary complications, and initial respiratory strategy were not independently associated. Among survivors (n = 811), extubation failure was associated with a higher incidence of moderate-to-severe BPD (50.6% vs. 18.7%; adjusted OR 3.07, 95% CI 1.79-5.24; p < 0.001). Infants with extubation failure also had significantly greater cumulative exposure to invasive ventilation (median 31 vs. 6 days; adjusted ratio 2.01, 95% CI 1.64-2.45; p < 0.001) and longer hospital stay (median 97 vs. 59 days; adjusted ratio 1.40, 95% CI 1.21-1.63; p < 0.001). Infection-related morbidities were more frequent, including late-onset sepsis (37.1% vs. 18.1%, p < 0.001) and ventilator-associated pneumonia (28.1% vs. 10.0%, p < 0.001).Conclusion
Extubation failure in very preterm infants was most strongly associated with lower gestational age and with a more adverse respiratory course, increased infection-related morbidity, and greater healthcare utilisation. Gestational age should be interpreted as one component of extubation risk assessment rather than as a standalone determinant of extubation readiness. Overall, these findings indicate that extubation failure identifies infants at increased risk of subsequent respiratory morbidity but should not be interpreted as an independent causal determinant of adverse outcomes.
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BibTeX
@article{ali2026extubation,
title = {{Extubation failure in very preterm infants: associations with respiratory outcomes in a nine-year cohort study.}},
author = {Kamal Ali and Talal Aljarbou and Saleh Algarni and Saad Alshareedah and Abadi Ghazwani and Naif Alotaibi and Maather Almutairi and Moudhi Alhumaidi and Nouf Alayyar and Mohammed AImahdi and Musab Alshareef and Ahmed Alwatban and Mohamed Khawaji and Abdulaziz Homedi and Saif Alsaif},
journal = {BMC pediatrics},
year = {2026},
month = jul,
doi = {10.1186/s12887-026-07399-w},
url = {https://europepmc.org/article/MED/42897501},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Extubation failure in very preterm infants: associations with respiratory outcomes in a nine-year cohort study.
AU - Kamal Ali
AU - Talal Aljarbou
AU - Saleh Algarni
AU - Saad Alshareedah
AU - Abadi Ghazwani
AU - Naif Alotaibi
AU - Maather Almutairi
AU - Moudhi Alhumaidi
AU - Nouf Alayyar
AU - Mohammed AImahdi
AU - Musab Alshareef
AU - Ahmed Alwatban
AU - Mohamed Khawaji
AU - Abdulaziz Homedi
AU - Saif Alsaif
PY - 2026
DA - 2026/07/01
JO - BMC pediatrics
DO - 10.1186/s12887-026-07399-w
UR - https://europepmc.org/article/MED/42897501
AB - Background Extubation failure is a common event in very preterm infants and has been associated with adverse respiratory and clinical outcomes. However, it remains unclear whether extubation failure independently contributes to subsequent morbidity or primarily reflects underlying respiratory disease severity.Methods We conducted a retrospective cohort study of ventilated infants born at less than 32 weeks of gestation in a tertiary neonatal intensive care unit over a 9-year period. Infants who underwent at least one planned extubation attempt were included. Extubation failure was defined as the need for reintubation within 72 h of planned extubation. Multivariate analyses were performed to identify independent predictors and to evaluate associations with moderate-to-severe bronchopulmonary dysplasia (BPD), duration of invasive ventilation, length of hospital stay, and infection-related morbidity.Results A total of 877 infants were included, of whom 89 (10.1%) experienced extubation failure. The incidence demonstrated a strong gestational age gradient, decreasing from 22.5% at less than 26 weeks to 4.9% at 30-31 + 6 weeks (p < 0.001). In multivariate analysis (n = 858), gestational age remained the only independent predictor of extubation failure among the variables available for analysis (adjusted OR 0.78 per week, 95% CI 0.65-0.94; p = 0.007), while birth weight, Apgar score, antenatal steroid exposure, surfactant requirement, early pulmonary complications, and initial respiratory strategy were not independently associated. Among survivors (n = 811), extubation failure was associated with a higher incidence of moderate-to-severe BPD (50.6% vs. 18.7%; adjusted OR 3.07, 95% CI 1.79-5.24; p < 0.001). Infants with extubation failure also had significantly greater cumulative exposure to invasive ventilation (median 31 vs. 6 days; adjusted ratio 2.01, 95% CI 1.64-2.45; p < 0.001) and longer hospital stay (median 97 vs. 59 days; adjusted ratio 1.40, 95% CI 1.21-1.63; p < 0.001). Infection-related morbidities were more frequent, including late-onset sepsis (37.1% vs. 18.1%, p < 0.001) and ventilator-associated pneumonia (28.1% vs. 10.0%, p < 0.001).Conclusion Extubation failure in very preterm infants was most strongly associated with lower gestational age and with a more adverse respiratory course, increased infection-related morbidity, and greater healthcare utilisation. Gestational age should be interpreted as one component of extubation risk assessment rather than as a standalone determinant of extubation readiness. Overall, these findings indicate that extubation failure identifies infants at increased risk of subsequent respiratory morbidity but should not be interpreted as an independent causal determinant of adverse outcomes.
SN - 1471-2431
ER -