Date of Award

January 2014

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Vineet Bhandari

Subject Area(s)

Medicine

Abstract

We hypothesized that early intubation would decrease the hazard of BPD and BPD/death in premature infants regardless of need for reintubation. Specific aims included assessing rates of BPD and BPD/death in infants first extubated between day of life (DOL)1-3 versus 4-7, 8+ and impact of re-intubation. We included infants with gestational age ≤28weeks, birth weight ≤1000g, and intubation on DOL1. Proportional hazards regression modeled time to BPD and BPD/death, adjusting for potential confounders. Of 262 infants, 101 (38.55%), 41 (15.65%) and 120 (45.80%) were extubated between DOL1-3, 4-7, and 8+, respectively. Extubation between DOL4-7 versus DOL1-3 was associated with an increased hazard of developing BPD (HR 1.7; 95%CI 1.0-2.8; p<0.05). Extubation on DOL 8+ was associated with a significantly increased hazard compared to extubation between DOL1-3 (16.9; 10.5-27.1; <0.0001) or DOL4-7 (10.0; 6.1-16.3; < 0.0001). Similar results were noted with BPD/death. Re-intubation did not affect BPD and BPD/death. Delaying extubation beyond the first 3 and 7 days was associated with an increased risk of BPD and BPD/death. Re-intubation did not impact outcomes.

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