Research: Variability for Age at Successful Extubation in Infants with Congenital Diaphragmatic Hernia (CDH)

J Pediatr

. 2022 Oct 3;S0022-3476(22)00853-8.

 doi: 10.1016/j.jpeds.2022.09.031. Online ahead of print.

Variability for Age at Successful Extubation in Infants with Congenital Diaphragmatic Hernia (CDH)

Nicolas Fm Porta 1Khatija Naing 2Sarah Keene 3Theresa R Grover 4Holly Hedrick 5Burhan Mahmood 6Ruth Seabrook 7John Daniel Iv 8Allen Harrison 9Mark F Weems 10Bradley A Yoder 11Robert DiGeronimo 12Beth Haberman 13Vedanta Dariya 14Yigit Guner 15Natalie E Rintoul 5Karna Murthy 16CHNC CDH Focus Group.Q

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Objective: To characterize clinical factors associated with successful extubation in infants with congenital diaphragmatic hernia (CDH).

Study design: Using the Children’s Hospitals Neonatal Database (CHND), we identified infants with CDH from 2017-2020 at 32 centers. The main outcome was age in days at time of successful extubation, defined as the patient remaining extubated for 7 consecutive days. Unadjusted Kaplan-Meier and multivariable Cox proportional hazards ratio (HR) equations were used to estimate associations between clinical factors and the main outcome. Observations occurred through 180 days after birth.

Results: There were 840 eligible neonates with median gestational age 38 weeks and birth weight 3.0 kg. Among survivors (n=693), the median age at successful extubation was 15 d (interquartile range [IQR]: 8-29 d, 95th %ile: 71 d). For non-survivors (n=147), the median age at death was 21 d (IQR: 11-39 d, 95th %ile: 110 d). Center (adjusted HR: 0.22 to 15, p<0.01), low birthweight, intrathoracic liver position, congenital heart disease, lower 5-minute Apgar score, lower pH upon admission to CHND center, and use of extracorporeal support were independently associated with older age at successful extubation. Tracheostomy was associated with multiple failed extubations.

Conclusion: Our findings suggest that infants who have not successfully extubated by about 3 months of age may be candidates for tracheostomy with chronic mechanical ventilation or palliation. The variability of timing of successful extubation among our centers supports the development of practice guidelines after validating clinical criteria.

Keywords: CHNC; neonate.

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