A Nomogram for Predicting Extubation Failure in Preterm Infants with Gestational Age Less than 29 Weeks

作者全名："Chen, Feifan; Chen, Yanru; Wu, Yumin; Zhu, Xingwang; Shi, Yuan"

作者地址："[Chen, Feifan; Zhu, Xingwang; Shi, Yuan] Chongqing Med Univ, Childrens Hosp, Natl Clin Res Ctr Child Hlth & Disorders,Chongqing, Dept Neonatol,Minist Educ,Key Lab Child Dev & Diso, Chongqing, Peoples R China; [Chen, Yanru] Sichuan Prov Hosp Women & Children, Dept Neonatol, Chengdu, Peoples R China; [Wu, Yumin] Qujing Matern & Child Hlth Care Hosp, Dept Neonatol, Qujing, Peoples R China"

通信作者："Shi, Y (通讯作者)，Chongqing Med Univ, Childrens Hosp, Natl Clin Res Ctr Child Hlth & Disorders,Chongqing, Dept Neonatol,Minist Educ,Key Lab Child Dev & Diso, Chongqing, Peoples R China."

来源：NEONATOLOGY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001008091100001

JCR分区：Q1

影响因子：2.6

年份：2023

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：Extubation; Extubation failure; Reintubation; Nomogram; Preterm infants

摘要："Introduction: How to avoid reintubations in prematurity remains a hard nut. This study aimed to develop and validate a nomogram for predicting extubation failure in preterm infants who received different modes of noninvasive ventilation as post-extubation support. Methods: This was a secondary analysis of pre-existing data from a large multicenter RCT combined with a multicenter retrospective investigation in three tertiary referral NICUs in China. The training cohort consisted of extubated infants from the RCT and the validation cohort included neonates admitted to the three NICUs in the last 5 years. The nomogram was developed through univariate and multivariate logistic regression analyses of peri-extubation clinical variables. Results: A total of 432 and 183 preterm infants (25 weeks <= gestational age [GA] <29 weeks) were, respectively, included in the training cohort and the validation cohort. Lower birth weight, lower Apgar 5-min score, lower postmenstrual age at extubation, lower PO2 and higher PCO2 before extubation, and continuous positive airway pressure rather than nasal intermittent positive pressure ventilation or noninvasive high-frequency oscillatory ventilation after extubation were associated with higher risks of extubation failure (p < 0.05), on which the nomogram was established. In both the training cohort and the validation cohort, the nomogram demonstrated good predictive accuracy (area under the receiver operating characteristic curve = 0.744 and 0.826); the Hosmer-Lemeshow test (p = 0.192 and 0.401) and the calibration curve (R-2 = 0.195 and 0.307) proved a good fitness and conformity; and the decision curve analysis showed significant net benefit at the best threshold (p = 0.201). Conclusion: This nomogram could serve as a good decision-support tool when predicting extubation failure in preterm infants with GA less than 29 weeks."

基金机构：National Key Research and Development Program of China [2022YFC2704803]

基金资助正文：This work was supported by the National Key Research and Development Program of China (2022YFC2704803).