Complicated Intubations are Associated with Bronchopulmonary Dysplasia in Very Low Birth Weight Infants

Abstract

Objective This study aimed to evaluate the association between desaturation <60% (severe desaturation) during intubation and a total number of intubation attempts in the first week of life in very low birth weight (VLBW) infants with adverse long-term outcomes including bronchopulmonary dysplasia (BPD) and severe periventricular/intraventricular hemorrhage grade 3 or 4 (PIVH).

Study Design A retrospective chart review was performed on VLBW infants intubated in the neonatal intensive care unit during the first week of life between January 2017 and July 2020. Descriptive tables were generated for two outcomes including BPD and PIVH. Multivariable logistic regression was performed for each outcome including significant predictors that differed between groups with a p-value of <0.2.

Results A total of 146 patients were included. Patients with BPD or PIVH had a lower gestational age, and patients with BPD had a lower BW. Patients with BPD had a greater number of intubation attempts in the first week of life (4 vs. 3, p < 0.001). In multivariable logistic regression controlling for confounding variables, the odds developing BPD were higher for patients with increased cumulative number of intubation attempts in the first week of life (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.03–1.62, p = 0.029). Post hoc analyses revealed increased odds of developing BPD with increased number of intubation encounters in the first week of life (OR: 2.20, 95% CI: 1.04–4.82, p = 0.043). In this post hoc analysis including intubation encounters in the model; desaturation <60% during intubation in the first week of life was associated with increased odds of developing BPD (OR: 2.35, 95% CI: 1.02–5.63, p = 0.048).

Conclusion The odds of developing BPD for VLBW infants were higher with increased intubation attempts and intubation encounters. In a post hoc analysis, the odds of developing BPD were also higher with desaturation during intubation. Further research is needed to determine mechanisms of the relationship between complicated intubations and the development of BPD.

Key Points

• Neonatal intubations often require multiple attempts.

• Neonates frequently desaturate during intubation.

• Intubation attempts are positively associated with BPD.

• Severe desaturation may be positively associated with BPD.

Keywords

neonatal endotracheal intubation - intubation complications - adverse events - patient safety - bronchopulmonary dysplasia - periventricular-intraventricular hemorrhage - very low birth weight infants

Publikationsverlauf

Eingereicht: 11. Mai 2021

Angenommen: 15. Juli 2021

Artikel online veröffentlicht:
09. September 2021

• References

• 1 O'Donnell CP, Kamlin CO, Davis PG, Morley CJ. Endotracheal intubation attempts during neonatal resuscitation: success rates, duration, and adverse effects. Pediatrics 2006; 117 (01) e16-e21
• 2 Hatch LD, Grubb PH, Lea AS. et al. Endotracheal intubation in neonates: a prospective study of adverse safety events in 162 infants. J Pediatr 2016; 168: 62-66.e6 , e6
• 3 Hatch LD, Grubb PH, Lea AS. et al. Interventions to improve patient safety during intubation in the neonatal intensive care unit. Pediatrics 2016; 138 (04) e20160069
• 4 Sawyer T, Foglia EE, Ades A. et al; National Emergency Airway Registry for Neonates (NEAR4NEOS) investigators. Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: a report from the National Emergency Airway Registry for Neonates. Arch Dis Child Fetal Neonatal Ed 2019; 104 (05) F461-F466
• 5 Glenn T, Sudhakar S, Markowski A, Malay S, Hibbs AM. Patient characteristics associated with complications during neonatal intubations. Pediatr Pulmonol 2021;
• 6 Wallenstein MB, Birnie KL, Arain YH. et al. Failed endotracheal intubation and adverse outcomes among extremely low birth weight infants. J Perinatol 2016; 36 (02) 112-115
• 7 Sauer CW, Kong JY, Vaucher YE. et al. Intubation attempts increase the risk for severe intraventricular hemorrhage in preterm infants-a retrospective cohort study. J Pediatr 2016; 177: 108-113
• 8 Chawla S, Natarajan G, Shankaran S. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Markers of successful extubation in extremely preterm infants, and morbidity after failed extubation. J Pediatr 2017; 189: 113-119.e2
• 9 Kidman AM, Manley BJ, Boland RA, Davis PG, Bhatia R. Predictors and outcomes of extubation failure in extremely preterm infants. J Paediatr Child Health 2021; 57 (06) 913-919
• 10 Jensen EA, DeMauro SB, Kornhauser M, Aghai ZH, Greenspan JS, Dysart KC. Effects of multiple ventilation courses and duration of mechanical ventilation on respiratory outcomes in extremely low-birth-weight infants. JAMA Pediatr 2015; 169 (11) 1011-1017
• 11 Berger J, Mehta P, Bucholz E, Dziura J, Bhandari V. Impact of early extubation and reintubation on the incidence of bronchopulmonary dysplasia in neonates. Am J Perinatol 2014; 31 (12) 1063-1072
• 12 Glenn TJ, Grathwol MM, McClary JD. et al. Decreasing time from decision to intubation in premedicated neonates: a quality improvement initiative. Pediatr Qual Saf 2019; 4 (06) e234
• 13 Foglia EE, Ades A, Sawyer T. et al; NEAR4NEOS Investigators. Neonatal intubation practice and outcomes: an international registry study. Pediatrics 2019; 143 (01) e20180902
• 14 Ozawa Y, Ades A, Foglia EE. et al; National Emergency Airway Registry for Neonates (NEAR4NEOS) Investigators. Premedication with neuromuscular blockade and sedation during neonatal intubation is associated with fewer adverse events. J Perinatol 2019; 39 (06) 848-856
• 15 Foglia EE, Ades A, Napolitano N, Leffelman J, Nadkarni V, Nishisaki A. Factors associated with adverse events during tracheal intubation in the NICU. Neonatology 2015; 108 (01) 23-29
• 16 Sawyer T, Foglia E, Hatch LD. et al. Improving neonatal intubation safety: a journey of a thousand miles. J Neonatal Perinatal Med 2017; 10 (02) 125-131