Accuracy of a spontaneous breathing trial for extubation of neonates

BACKGROUND: Prevalence of extubation failure in neonates may be up to 80%, but evidence to determine if a neonate is ready for extubation remains unclear. We aim to evaluate a spontaneous breathing trial accuracy with minimum pressure support to predict success in neonates’ extubation and identify variables related to failures. METHODS: This is a diagnostic accuracy study based on a cohort study in an intensive care unit with all eligible newborn infants subjected to invasive mechanical ventilation for at least 24 hours submitted to the trial for 10 minutes before extubations. The outcome was failures of extubations, considered if reintubation was needed until 72 hours. RESULTS: The incidence of failure was 14.7%among 170 extubations. There were 145 successful extubations; of these, 140 also passed the trial with a sensitivity of 96.5%(95%CI: 92.1–98.9). Of the 25 extubations that eventually failed, 16 failed the test with a specificity of 64.0%(95%CI: 42.5–82.0). The negative predictive value was 76.2%, and the positive predictive value was 94%. In stratifying by weight, the accuracy was >98.7%for neonates weighting >2500 g, but 72.5%for those weighing <1250 g. Extubation failures occurred more frequently in smaller (p = 0.01), preterm infants (p = 0.17), with longer ventilation time (p = 0.05), and having a hemodynamically significant persistent arterial duct (p = 0.01), compared with infants whose extubation was successful. CONCLUSION: The spontaneous breathing trial with minimum pressure support ventilation seems to predict extubation success with great accuracy in full-term and larger neonates.

Morbidity in extreme low birth weight newborns hospitalized in a high risk public maternity

Objectives: to determine the prevalence of the most common morbidities in extremely low birth weight (ELBW) infants hospitalized in a newborn intensive care unit (NICU) and to evaluate the influence of these morbidities through the length of in-hospital stay. Methods: observational, longitudinal, prospective and analytical study in a high risk reference maternity NICU from Sergipe, realized with 158 ELBW infants admitted between March 2014 and April 2015. The analysis of the hospitalization time was realized through the Kaplan-Meier method. Results: the average weight of premature was 785,2g ± 138,2g. The gestational age vary from 22 to 35 weeks and the average was 26,8 weeks. Of those admitted at NICU, sixty three (39,9%) were discharged and 95 (60,1%) died. The time of hospitalization was influenced for morbidities as: patent ductus arteriosus (PDA), intraventricular hemorrhage and sepsis. Acute respiratory distress syndrome was the most common complication (157 - 99,4%). The incidence of persistent arterial duct, intraventricular hemorrhage, sepsis, hypothermia, hypoglycemia and retinopathy of prematurity was 39,2%, 17,1%, 32,3%,50,3%, 52,3% e 16,6% respectively. Conclusions: the morbidities from respiratory tract, cardiac, neurological and infectious were the most prevalent, whilst PDA, intraventricular hemorrhage and sepsis were the morbidities that significantly influenced the time of hospitalization.