title: Risk Factors for Extubation Failure Following Neonatal Cardiac Surgery.
abstract: OBJECTIVE
  Extubation failure after neonatal cardiac surgery has been associated with considerable postoperative morbidity, although data identifying risk factors for its occurrence are sparse. We aimed to determine risk factors for extubation failure in our neonatal cardiac surgical population.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Urban tertiary care free-standing children's hospital.
  
  
  METHODS
  Neonates (0-30 d) who underwent cardiac surgery at our institution between January 2009 and December 2012 was performed.
  
  
  METHODS
  Extubation failure was defined as reintubation within 72 hours after extubation from mechanical ventilation. Multivariate logistic regression analysis was performed to determine independent risk factors for extubation failure.
  
  
  RESULTS
  We included 120 neonates, of whom 21 (17.5%) experienced extubation failure. On univariate analysis, patients who failed extubation were more likely to have genetic abnormalities (24% vs 6%; p = 0.023), hypoplastic left heart (43% vs 17%; p = 0.009), delayed sternal closure (38% vs 12%; p = 0.004), postoperative infection prior to extubation (38% vs 11%; p = 0.002), and longer duration of mechanical ventilation (median, 142 vs 58 hr; p = 0.009]. On multivariate analysis, genetic abnormalities, hypoplastic left heart, and postoperative infection remained independently associated with extubation failure. Furthermore, patients with infection who failed extubation tended to receive fewer days of antibiotics prior to their first extubation attempt when compared with patients with infection who did not fail extubation (4.9 ± 2.6 vs 7.3 ± 3; p = 0.073).
  
  
  CONCLUSIONS
  Neonates with underlying genetic abnormalities, hypoplastic left heart, or postoperative infection were at increased risk for extubation failure. A more conservative approach in these patients, including longer pre-extubation duration of antibiotic therapy for postoperative infections, may be warranted.
authors.affiliation: 1Department of Pediatrics, Wayne State University/Children's Hospital of Michigan, Detroit, MI. 2Division of Cardiology, Department of Pediatrics, Wayne State University/Children's Hospital of Michigan, Detroit, MI. 3Department of Cardiovascular Surgery, Wayne State University/Children's Hospital of Michigan, Detroit, MI. 4Division of Critical Care, Department of Pediatrics, Indiana University/Riley Hospital for Children, Indianapolis, IN.
authors.forename: Nina
authors.initials: N
authors.lastname: Laudato
authors.forename: Pooja
authors.initials: P
authors.lastname: Gupta
authors.forename: Henry L
authors.initials: HL
authors.lastname: Walters
authors.forename: Ralph E
authors.initials: RE
authors.lastname: Delius
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Mastropietro
mesh_terms: D060666:Airway Extubation; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004062:DiGeorge Syndrome / Q000150:complications*; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications*; D007231:Infant, Newborn; D007239:Infections / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D011184:Postoperative Period; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents