Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct;34(12):1234-1240.
doi: 10.1055/s-0037-1603341. Epub 2017 May 11.

Effect of Anatomical and Developmental Factors on the Risk of Unplanned Extubation in Critically Ill Newborns

L Dupree Hatch  1 , Peter H Grubb  1 , Melinda H Markham  1 , Theresa A Scott  1 , William F Walsh  1 , James C Slaughter  2 , Ann R Stark  1 , E Wesley Ely  3   4
Affiliations

Effect of Anatomical and Developmental Factors on the Risk of Unplanned Extubation in Critically Ill Newborns

L Dupree Hatch et al. Am J Perinatol. 2017 Oct.

Abstract

Objective: To quantify the daily risk of unplanned extubation (UE) in newborns based on developmental and anatomical factors.

Methods: Prospective cohort of ventilated newborns over an 18-month period in a level IV neonatal intensive care unit (NICU). We captured UEs through four data streams. We generated multivariable logistic regression models to assess the association of UE with chronological age, birth weight, and postmenstrual age.

Results: During the study, 718 infants were ventilated for 5,611 patient days with 117 UEs in 81 infants. The daily risk of UE had a significant, nonlinear relationship (p < 0.01) with chronological age, decreasing until day 7 (odds ratio [OR]: 0.5; 95% confidence interval [CI]: 0.17–1.47) and increasing after day 7 (day 7–28, OR: 1.36, 95% CI: 1.06–1.75; and >28 days, OR: 1.06, 95% CI: 1.0–1.14). Birth weight and postmenstrual age were not associated with UE. Adverse events occurred in 83/117 (71%) UE events. Iatrogenic causes of UE were more common in younger, smaller infants, whereas older, larger infants were more likely to self-extubate.

Conclusion: The daily risk and causes of UE change over the course of an infant’s NICU hospitalization. These data can be used to identify infants at the highest risk of UE for whom targeted proactive interventions can be developed.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Fig. 1
Fig. 1
Flowchart of hospital days/infants included in the study cohort.
Fig. 2
Fig. 2
Predicted daily unplanned extubation risk (solid line) with 95% confidence intervals (shading) by chronological age adjusted for a 32-week gestation, 1,800-g birth weight infant based on ourmodel. For a newborn with different characteristics at birth, the daily predicted probability could be higher or lower, but the curve would remain the same shape. *Each odds ratio indicates the change in risk of unplanned extubation for a 7-day change in chronological age. For example, a 14-day-old infant would have a 36% higher risk of unplanned extubation than a 7-day-old infant.
See this image and copyright information in PMC

References

    1. Horimoto Y, Tomie H, Hanzawa K, Nishida Y. Accidental extubations during respiratory management in a children’s hospital. J Anesth. 1991;5(02):142–145. - PubMed
    1. Loughead JL, Brennan RA, DeJuilio P, Camposeo V, Wengert J, Cooke D. Reducing accidental extubation in neonates. Jt Comm J Qual Patient Saf. 2008;34(03):164–170. 125. - PubMed
    1. Veldman A, Trautschold T, Weiss K, Fischer D, Bauer K. Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit. Paediatr Anaesth. 2006;16(09):968–973. - PubMed
    1. 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. - PMC - PubMed
    1. Fontánez-Nieves TD, Frost M, Anday E, Davis D, Cooperberg D, Carey AJ. Prevention of unplanned extubations in neonates through process standardization. J Perinatol. 2016;36(06):469–473. - PubMed

Publication types