The Optimal Predictors of Readiness for Extubation in
Low Birth Weight Infants
Waricha Janjindamai MD*,
Sitapa Pasee MD**, Anucha Thatrimontrichai MD*
Affiliation :
* Division of Neonatology, Department of Pediatrics, Prince of Songkla University, Songkhla, Thailand
** Division of Neonatology, Department of Pediatrics, Phuket Hospital, Phuket, Thailand
Background : Reintubation, following an unsuccessful extubation from mechanical ventilation is traumatic to the infant and
the family. However, 20 to 40% of infants fail extubation and reintubation.
Objective : Determine the optimal predictors of readiness for extubation in low birth weight infants during endotracheal tube-
continuous positive airway pressure (ET CPAP) for three minutes. The primary outcome was reintubation within 72 hours of
extubation and the secondary outcomes were the causes and risk factors of reintubation.
Material and Method: A prospective cohort study was undertaken in 51 mechanically ventilated infants who were considered
to be ready for extubation. The infants were changed to ET CPAP for a 3-minute spontaneous breathing test (SBT) before
extubated. Infants were divided into two groups based upon whether they failed or passed the extubation attempt. Extubation
failure was defined as reintubation within 72 hours of extubation.
Results : Forty-five of 51 infants (88%) were successfully extubated. Out of the 51 infants only one infant failed the SBT. The
three predictors of extubation success that included the SBT, ratio of minute ventilation during ET CPAP to mechanical
ventilation and ratio of respiratory frequency during ET CPAP to mechanical ventilation were not significantly different. Using
synchronized nasal intermittent positive pressure ventilation after extubation in the failed extubation group was significantly
higher than the successful extubation group (66.7% vs. 15.7%, p = 0.02).
Conclusion : The SBT and minute ventilation ratio in low birth weight infants were not optimal predictors of readiness for
extubation. However, a further prospective study in this field with a larger number of subjects and a proper indication for
extubation should be considered.
Keywords : Extubation, Low birth weight infant, Predictor, Preterm infant
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