2018, Number 3
An Med Asoc Med Hosp ABC 2018; 63 (3)
Mercado AL, Ramírez HJL, Iglesias LJ, Bernárdez ZI, Braverman BA
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ABSTRACTBackground: Respiratory pathology is the main morbidity in the newborn. Restricting the exposure to ventilatory support improves the patient’s outcome. Extubation results have been studied comparing different weaning ventilatory modes. Objective: To compare the different outcomes of newborns under mechanical ventilation depending on the post-extubation support: headbox oxygen, nasal continuous positive airway pressure, high-flow nasal cannula. Methodology: Prospective cohort; 44 newborns intubated within 72 hours of birth, extubated to high-flow nasal cannula, headbox oxygen or nasal continuous positive airway pressure. We present descriptive statistics to analyze the neonatal features and medical support, and the outcomes of interest, including death, days of oxygen need, sepsis, intraventricular hemorrhage, retinopathy, days of stay. We adjusted a bivariate logistic regression model to estimate the association between neonatal features and bronchopulmonary dysplasia and the need for reintubation. Results: Patients with more days of stay, more days of oxygen need, and a higher incidence of reintubation had been extubated to high-flow nasal cannula. Regarding the association of reintubation and bronchopulmonary dysplasia rates with the neonatal features, we found that higher birth weight (odds ratio 0.998, confidence interval 95%: 0.997-0.999, p = 0.016 and odds ratio 0.998, confidence interval 95%: 0.997-0.999, p = 0.02) and older gestational age (odds ratio 0.69, confidence interval 95%: 0.4-0.89, p = 0.012 and odds ratio 0.6, confidence interval 95%: 0.54-0.9, p = 0.005) decreased both probabilities. Conclusion: Newborn extubation to high-flow nasal cannula is associated to more days of stay and more days of oxygen need compared to nasal continuous positive airway pressure and headbox oxygen; however, it does not increase the risk of complications.