title: Impact of early extubation and reintubation on the incidence of bronchopulmonary dysplasia in neonates.
abstract: OBJECTIVE
  The objective of this study was to assess rates of bronchopulmonary dysplasia (BPD) and BPD/death in infants first extubated between day of life (DOL) 1 to 3 versus 4 to 7, 8+, and impact of reintubation.
  
  
  METHODS
  We included infants with gestational age ≤ 28 weeks, birth weight ≤ 1,000 g, and intubation on DOL 1. Proportional hazards regression modeled time to BPD and BPD/death, adjusting for potential confounders.
  
  
  RESULTS
  Of 262 infants, 101 (38.55%), 41 (15.65%), and 120 (45.80%) were extubated between DOL 1 to 3, 4 to 7, and 8+, respectively. Extubation between DOL 4 to 7 and DOL 1 to 3 was associated with an increased hazard of developing BPD (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.0-2.8; p < 0.05). Extubation on DOL 8+ was associated with a significantly increased hazard compared with extubation between DOL 1 to 3 (HR, 16.9; 95% CI, 10.5-27.1; p < 0.0001) and DOL 4 to 7 (HR, 10.0; 95% CI, 6.1-16.3; p < 0.0001). Similar results were noted with BPD/death. Reintubation did not affect BPD and BPD/death.
  
  
  CONCLUSIONS
  Delaying extubation beyond the first 3 and 7 days was associated with an increased risk of BPD and BPD/death. Reintubation did not impact outcomes.
authors.affiliation: Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Jessica
authors.initials: J
authors.lastname: Berger
authors.affiliation: Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Paulomi
authors.initials: P
authors.lastname: Mehta
authors.affiliation: Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Emily
authors.initials: E
authors.lastname: Bucholz
authors.affiliation: Yale Center for Analytical Sciences, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: James
authors.initials: J
authors.lastname: Dziura
authors.affiliation: Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Vineet
authors.initials: V
authors.lastname: Bhandari
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects*; D001034:Apgar Score; D001724:Birth Weight; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D018572:Disease-Free Survival; D004374:Ductus Arteriosus, Patent / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000453:epidemiology; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D012178:Retinopathy of Prematurity / Q000453:epidemiology; D019233:Retreatment / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors