Table 2 Summary characteristics of the 34 studies included in this review
From: Predictors of extubation failure in newborns: a systematic review and meta-analysis
Author | Country of study | Year of publication (data) | Study Design | Exclusions in study | Study population | Sample size | EF rate | Criteria for reintubation | Definition of EF | Post-extubation respiratory support | Study quality |
|---|---|---|---|---|---|---|---|---|---|---|---|
Alaa et al [46] | Qatar | 2021 (2016–2017) | Retrospective | 1 congenital anomalies;2 IVH(grade III and IV) | 28–36 weeks gestational age | 220 | 18 (8.2%) | FiO2 > 0.35–0.40;frequent or severe apnea;blood gas pH < 7.25 and/ or PCO2 > 60 mmHg | reintubation within 7 days of extubation | NCPAP; NIPPV; NC | Low |
Bahgat et al [30] | Egypt | 2021 (2017–2019) | Prospective | 1 congenital anomalies; 2 accidental extubation;3 pleural effusion |  < 32 weeks gestational age | 43 | 9 (20.9%) | FiO2 > 0.6;blood gas pH < 7.25and/ or PCO2 > 65 mmHg;frequent or severe apnea | reintubation within 72 h of extubation | NCPAP | High |
Bhat et al [25] | Britain | 2016 (Not mentioned) | Prospective | major congenital abnormalities | All gestations | 60 | 12 (20.0%) | frequent or severe apnea; blood gas pH < 7.2 or failure to improve despite instituting CPAP | reintubation within 48 h of extubation | NCPAP | High |
Chawla et al [33] | America | 2013 (2008–2009) | Prospective | accidental extubation; |  < 32 weeks gestational age | 49 | 10 (20.4%) | increase in FiO2 of > 40% baseline;blood gas pH < 7.25 and/ or PCO2 > 60 mmHg; frequent or severe apnea | reintubation within 72 h of extubation | NCPAP;HFNC;NIPPV;NC | Low |
Chawla et al [17] | America | 2017 (2005–2009) | Prospective | 1 congenital anomalies; 2 death before extubation; 3 accidental extubation;4 transfer | 24–27 weeks gestational age | 926 | 388 (41.9%) | FiO2 > 0.5;blood gas PCO2 > 65 mmHg; frequent apnea;clinical shock, sepsis, and/or the need for surgery | reintubation within 5 days of extubation | Not mentioned | Moderate |
Chen et al [41] | China | 2022 (2017–2021) | Retrospective | 1 death before extubation; 2 accidental extubation; 3 congenital anomalies |  ≤ 1500 g birth weight | 60 | 13 (21.7%) | Not mentioned | reintubation within 72 h of extubation | NIV or NCPAP | Moderate |
Cheng et al [49] | China | 2021 (2015–2020) | Retrospective | 1 congenital anomalies; 2 accidental extubation; 3 death before extubation;4 missing data;5surgical | 25–29 weeks gestational age | 128 | 55 (43.0%) | FiO2 > 0.6–0.7;blood gas pH < 7.2and/ or PCO2 > 60-65 mmHg; frequent apnea; required PS treatment | reintubation within 5 days of extubation | Not mentioned | Moderate |
Dassios et al [34] | Britain | 2017 (2016) | Prospective | 1 congenital anomalies; 2 accidental extubation |  < 34 weeks gestational age | 46 | 23 (50.0%) | FiO2 > 0.5;blood gas pH < 7.25 and/ or PCO2 > 55-60 mmHg;frequent or severe apnea | reintubation within 72 h of extubation | NCPAP;HFNC;NIPPV; | Low |
Devadas et al [24] | India | 2019 (2015–2017) | Prospective | 1 congenital anomalies; 2 IVH(grade III and IV);3 death before extubation;4 perinatal asphyxia |  > 26 weeks gestational age; > 600 g birth weight | 93 | 41 (44.1%) | FiO2 ≥ 0.5; blood gas pH < 7.25 and/ or PCO2 > 65 mmHg; frequent or severe apnea; Downes score ≥ 6 | reintubation within 48 h of extubation | NCPAP or head box oxygen | High |
Dimitriou et al [27] | Britain | 2002 (Not mentioned) | Prospective | Not mentioned |  < 37 weeks gestational age | 36 | 7 (19.4%) | severe apnoea; blood gas pH < 7.2; failed to improve despite the institution of CPAP | reintubation within 48 h of extubation | NCPAP or head box oxygen | Moderate |
Dimitriou et al [26] | Greece | 2011 (2007–2008) | Prospective | 1 congenital anomalies; 2 congenital infections |  < 37 weeks gestational age | 56 | 8 (14.3%) | severe stridor and apnea with bradycardia; requiring bag ventilation; blood gas pH < 7.2 or required FiO2 0.6 | reintubation within 48 h of extubation | NCPAP or head box oxygen | High |
Dursun et al [10] | Turkey | 2021 (2016–2020) | Retrospective | 1 death before extubation;2 accidental extubation; 3congenital anomalies; 4 transfer |  < 30 weeks gestational age; < 1250 g birth weight | 142 | 43 (30.2%) | blood gas pH < 7.2 and/ or PCO2 > 65 mmHg; failure to sustain target oxygen saturation; frequent or severe apnea | reintubation within 72 h of extubation | NCPAP or NIPPV | Low |
Gupta et al [42] | America | 2019 (2009–2015) | Retrospective | 1 death before extubation;2 missing data |  < 1250 g birth weight | 312 | 84 (26.9%) | frequent or severe apnea; blood gas pH < 7.2 and/ or PCO2 > 65 mmHg | reintubation within 5 days of extubation | NCPAP; NIPPV; NC | Moderate |
Hathlol et al [40] | Saudi Arabia | 2017 (2000–2014) | Retrospective | 1 death before extubation; 2 missing data;3chromosomal or congenital anomalies |  ≤ 1500 g birth weight | 394 | 47 (11.9%) | primarily on clinical assessment, blood gas levels, and ventilatory parameters | reintubation within 72 h of extubation | NCPAP or NIMV | Moderate |
He et al [43] | China | 2022 (2016–2020) | Retrospective | 1 congenital anomalies;2 request for discharge;3 pulmonary hypoplasia |  < 32 weeks gestational age | 359 | 110 (30.6%) | blood gas pH < 7.2 and/ or PCO2 > 65 mmHg;FiO > 0.6;frequent apnea; clinical shock;sepsis;surgery | reintubation within 72 h of extubation | NCPAP or NIPPV | Low |
Hermeto et al [44] | Canada | 2009 (2002–2004) | Retrospective | 1 congenital anomalies;2 transfer;3missing data |  < 1250 g birth weight | 39 | 9 (23.1%) | blood gas pH < 7.25 and/ or PCO2 > 65 mmHg;frequent or severe apnea; need for oxygen higher than 50% in CPAP | reintubation within 7 days of extubation | NCPAP | Moderate |
Hilal et al [45] | Oman | 2022 (2013–2017) | Retrospective | 1 death before extubation;2 palliative or comfort care; 3accidental extubation; 4 transfer |  < 37 weeks gestational age | 140 | 34 (24.3%) | desaturation and bradycardia;apnoea and respiratory failure | reintubation within 7 days of extubation | NCPAP;NHF; NIPPV | Moderate |
Hiremath et al [28] | India | 2009 (Not mentioned) | Prospective | 1 congenital anomalies;2 HIE stage III or IVH grade 4 | All gestations | 82 | 22 (26.8%) | increase in FiO2of > 50% baseline;increase in respiratory rate of > 25% baseline; Downe’score > 6;Silverman’ score ≥ 7;PaO2 < 50 mmHg, or PCO2 > 60 mmHg | reintubation within 48 h of extubation | NCPAP or head box oxygen | Moderate |
Hunt et al [31] | Britain | 2020 (2016–2018) | Prospective | congenital anomalies | All gestations | 72 | 15 (20.8%) | FiO2 > 0.7;blood gas pH < 7.2;frequent apnea | reintubation within 48 h of extubation | NCPAP;HFNC;incubator oxygen | High |
Kaczmarek et al [23] | Canada | 2013 (2010–2011) | Prospective | 1 congenital anomalies; 2 congenital heart disease;3 used vasopressors/sedation |  < 1250 g birth weight | 47 | 11 (23.4%) | FiO2 > 0.5;blood gas pH < 7.25 and/ or PCO2 > 55-60 mmHg;frequent apnea; significantly increased work of breathing | reintubation within 72 h of extubation | NCPAP or NIPPV | Moderate |
Kaczmarek et al [52] | Canada | 2013 (2005–2006) | Retrospective | 1 congenital anomalies; 2 missing data;3 death before extubation |  < 1250 g birth weight | 44 | 8 (18.2%) | FiO2 > 0.6;blood gas pH < 7.25 and/ or PCO2 > 65 mmHg;frequent or severe apnea | reintubation within 72 h of extubation | NCPAP or NIPPV | High |
Kamlin et al [35] | Australia | 2006 (2003–2004) | Prospective | mechanical ventilation for less than 24 h |  < 1250 g birth weight | 50 | 11 (22.0%) | FiO2 > 0.6;blood gas pH < 7.25 and/ or PCO2 > 65 mmHg;frequent or severe apnea | reintubation within 72 h of extubation | NCPAP or NIPPV | High |
Kidman et al [16] | Australia | 2021 (2016–2017) | Retrospective | 1 death before extubation;2 accidental extubation |  < 28 weeks gestational age | 204 | 96 (47.1%) | apnoea;increasing FiO2 requirement; respiratory acidosis | reintubation within 7 days of extubation | NCPAP;NHF; NIPPV | Moderate |
Manley et al [19] | Australia | 2016 (2010–2012) | Prospective | 1 congenital anomalies;2 not providing maximal intensive care |  < 28 weeks gestational age | 174 | 56 (32.2%) | increase in FiO2 of > 20% baseline;blood gas pH < 7.2 and/ or PCO2 > 60 mmHg; frequent or severe apnea; urgent need | reintubation within 7 days of extubation | NIPPV or HFNC | High |
Menshykova et al [36] | Ukraine | 2017 (Not mentioned) | Prospective | Not mentioned |  < 1500 g birth weight | 92 | 27 (29.3%) | FiO2 ≥ 0.6;blood gas pH < 7.25 and/ or PCO2 ≥ 55 mmHg;frequent or severe apnea | reintubation within 72 h of extubation | NCPAP;HFNC;NIV | Moderate |
Mhanna et al [47] | America | 2017 (2009–2012) | Retrospective | 1 death before extubation; 2 admission for comfort care |  < 1500 g birth weight | 147 | 45 (30.6%) | FiO2 > 0.5;blood gas pH < 7.2 and/ or PCO2 > 65 mmHg | reintubation within 48 h of extubation | NCPAP; NIMV;NC | Low |
Mohsen et al [29] | Canada | 2023 (2019–2021) | Prospective | 1 congenital anomalies;2 pneumothorax;3 pleural effusion;4 use muscle relaxant; |  < 28 weeks gestational age | 45 | 9 (20.0%) | FiO2 > 0.4–0.5;blood gas pH < 7.2 and/ or PCO2 > 65 mmHg; frequent or severe apnea | reintubation within 72 h of extubation | NIPPV | Low |
Ohnstad et al [39] | Norway | 2022 (2013–2018) | Prospective | 1 death before extubation; 2 accidental extubation; 3 missing data |  < 26 weeks gestational age | 316 | 143 (45.3%) | Not mentioned | reintubation within 72 h of extubation | NCPAP or BiPAP | High |
Shalish et al [37] | Canada | 2020 (2013–2018) | Prospective | 1 congenital anomalies; 2 death before extubation; 3 accidental extubation;; 4 used vasopressors/sedation |  < 1250 g birth weight | 259 | 75 (29.0%) | FiO2 > 0.6;blood gas pH < 7.25 and/ or PCO2 > 65 mmHg;frequent or severe apnea | reintubation within 7 days of extubation | NCPAP or NIPPV | Moderate |
Spaggiari et al [50] | Italy | 2022 (2010–2019) | Retrospective | 1 congenital anomalies;2 accidental extubation;3 intubation after the first 24 h of life |  < 28 weeks gestational age; < 1000 g birth weight | 80 | 29 (36.2%) | blood gas pH < 7.2 and/ or PCO2 > 65 mmHg;frequent apnea | reintubation within 72 h of extubation | NCPAP | Low |
Su et al [48] | Korea | 2023 (2017–2021) | Retrospective | 1 death before extubation; 2 transfer |  < 32 weeks gestational age | 129 | 24 (18.6%) | FiO2 above the initial value;SARS > 4;frequent or severe apnea;blood gas pH < 7.2 and/ or PCO2 > 65 mmHg | reintubation within 7 days of extubation | NCPAP or HFNC | Low |
Teixeira et al [32] | Brazil | 2020 (2018–2019) | Prospective | 1 congenital anomalies; 2 death before extubation; 3 missing data |  < 1500 g birth weight | 112 | 26 (23.2%) | FiO2 > 0.5;blood gas pH < 7.2 and/ or PCO2 > 55-60 mmHg; frequent apnea; significantly increased work of breathing | reintubation within 7 days of extubation | NCPAP or NIPPV | Moderate |
Wang et al [51] | China | 2017 (2009–2013) | Retrospective | 1 death before extubation;2 congenital anomalies |  < 1000 g birth weight | 68 | 16 (23.5%) | FiO2 > 0.6;blood gas pH < 7.25 and/ or PCO2 > 65 mmHg; frequent apnea; significantly increased work of breathing | reintubation within 7 days of extubation | NCPAP or NIPPV | Low |
Williams et al [38] | Britain | 2022 (2020–2021) | Prospective | congenital lung or diaphragmatic anomalies |  < 37 weeks gestational age | 48 | 13 (27.1%) | FiO2 > 0.6;blood gas pH < 7.25 and/ or PCO2 > 65 mmHg;severe apnea | reintubation within 48 h of extubation | NCPAP or HFNC | Moderate |