297 - Time To Extubation In Infants With Bronchopulmonary Dysplasia Receiving Corticosteroids: Can We Extubate Faster?

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 297
Publication Number: 297.344

Estefani Hee Chung, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, United States; Andrew Ellefson, Sidney Kimmel Medical College at Thomas Jefferson University, Newark, DE, United States; David A. Paul, Pediatrics, Newark, DE, United States

Presenting Author(s)

Estefani Hee Chung, MD (she/her/hers)

Neonatal-Perinatal Medicine Fellow
Sidney Kimmel Medical College at Thomas Jefferson University
Wilmington, Delaware, United States

Background: Prolonged invasive ventilation in preterm infants increases the risk for lung injury. Postnatal corticosteroid treatment is often used to facilitate weaning and earlier extubation in infants with bronchopulmonary dysplasia (BPD). The efficiency of weaning ventilator settings and successfully extubating infants during the provision of postnatal corticosteroids has not been extensively studied

Objective:

The aim of this study is to compare time to extubation readiness verses time to actual extubation in a cohort of infants with BPD receiving corticosteroids.

Design/Methods:

A single-center retrospective cohort study was conducted of all intubated infants treated with postnatal corticosteroids between January 2016 to December 2021 in a regional perinatal referral center. Patients treated with dexamethasone or both hydrocortisone and dexamethasone while intubated were included. Patients treated with hydrocortisone or prednisolone as monotherapy or who received steroids on noninvasive support were excluded. Extubation readiness was defined as ventilator rate ≤ 20 breaths/minute and fraction of inspired oxygen (FiO2) < 40%. Successful extubation was defined as remaining extubated for ≥ 48 hours. Day shift was defined as 07:00 to 19:00. Statistical analysis included T-test and Chi-Square. A p value < 0.05 was considered significant.

Results:

The study sample included 273 babies who were diagnosed with moderate to severe BPD of which 44 (16%) met the inclusion criteria. Patients analyzed had a mean gestational age of 25.5 ± 1.4 weeks, birth weight of 742 ± 148 g and were initiated on postnatal corticosteroids on day of life 46 ± 17. At the end of the 1st course, 33 (75%) reached extubation readiness at 56.4 ± 51.6 hours were extubated at 94.1 ± 48.6 hours after starting corticosteroids (p< .01). The timing of extubation was not evenly distributed with 67% of occurring during the 12-hour day shift. Of the 13 patients that remained ventilated, 9 received a 2^nd course of corticosteroids; extubation readiness occurred at 40.6 ± 23.5 and extubation at 122.6 ± 60.5 hours (p=0.05).

Conclusion(s):

In our study sample there was a delay in extubation after achieving extubation readiness during the 1^st and 2^nd course of corticosteroids. This highlights significant variation in extubation practices and suggests a need for unit-based performance improvement in the reduction of time on mechanical ventilation during administration of postnatal corticosteroids.