title: Is extubation associated with changes in ductal and pulmonary blood flow in extremely preterm neonates?
abstract: OBJECTIVE
  Early extubation is desirable in preterm neonates to minimise the risk of complications associated with prolonged intubation. The association of significant pulmonary haemorrhage (PH) with extubation in a cluster of very preterm infants instigated an assessment of ductal and pulmonary haemodynamic effects of early extubation.
  
  
  METHODS
  This is a prospective observational study in 20 neonates (gestation <28 weeks) undergoing early extubation. Echocardiography was performed 5 min pre-extubation and 20 min post-extubation to continuous positive airway pressure. Normal cardiac anatomy was ascertained. Left pulmonary artery (LPA) and ductus arteriosus diameter and flows were recorded. Doppler spectral pattern of velocity was recorded over a minimum of four cycles.
  
  
  RESULTS
  Median (range) gestation, birthweight and age at extubation were 26.5 (24.0-28.0) weeks, 932 (595-1260) g and 18 (6-51) h, respectively. There was no significant change in pulmonary flow post-extubation: ductal size: (pre--1.2 (0-3.3) mm, post--1.0 (0-3.5) mm); ductal flow: (pre--44 (0-515), post--49 (0-441) mL/kg/min); LPA diameter: (pre--2.4 (1.9-3.8) mm, post--2.6 (1.9-3.4) mm); LPA flow: (pre--112 (59-255), post--122 (58-188) mL/kg/min. There were 3 out of 20 infants who developed PH at the post-natal age of 2, 11 and 16 days after extubation. Ductal and LPA flow did not change significantly after extubation in infants with or without PH irrespective of the ductal status.
  
  
  CONCLUSIONS
  Early extubation was not associated with a significant change from baseline in ductal and pulmonary flow in extremely preterm infants.
authors.affiliation: Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia; Centre for Neonatal Education and Research, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Deepika
authors.initials: D
authors.lastname: Wagh
authors.forename: Andrew
authors.initials: A
authors.lastname: Gill
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging / Q000502:physiology*; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D062071:Infant, Extremely Premature / Q000502:physiology*; D007231:Infant, Newborn; D008171:Lung Diseases / Q000209:etiology; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000502:physiology*; D012039:Regional Blood Flow; D018608:Ultrasonography, Doppler
keywords: ductus arteriosus; infant; preterm; pulmonary haemorrhage