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Is extubation associated with changes in ductal and pulmonary blood flow in extremely preterm neonates?

Authors

  • Deepika Wagh,

    1. Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
    2. Centre for Neonatal Education and Research, University of Western Australia, Perth, Western Australia, Australia
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  • Andrew Gill

    Corresponding author
    1. Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
    2. Centre for Neonatal Education and Research, University of Western Australia, Perth, Western Australia, Australia
    • Correspondence: A/Professor Andrew W Gill, Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, 374 Bagot Road, Subiaco, Perth, WA 6008, Australia. Fax: +61 8 93401266; email: andy.gill@health.wa.gov.au

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  • Conflict of interest: The authors have no conflicts of interest to declare.

Abstract

Aim

Early extubation is desirable in preterm neonates to minimise the risk of complications associated with prolonged intubation. The association of significant pulmonary haemorrhage (PH) with extubation in a cluster of very preterm infants instigated an assessment of ductal and pulmonary haemodynamic effects of early extubation.

Method

This is a prospective observational study in 20 neonates (gestation <28 weeks) undergoing early extubation. Echocardiography was performed 5 min pre-extubation and 20 min post-extubation to continuous positive airway pressure. Normal cardiac anatomy was ascertained. Left pulmonary artery (LPA) and ductus arteriosus diameter and flows were recorded. Doppler spectral pattern of velocity was recorded over a minimum of four cycles.

Results

Median (range) gestation, birthweight and age at extubation were 26.5 (24.0–28.0) weeks, 932 (595–1260) g and 18 (6–51) h, respectively. There was no significant change in pulmonary flow post-extubation: ductal size: (pre – 1.2 (0–3.3) mm, post – 1.0 (0–3.5) mm); ductal flow: (pre – 44 (0–515), post – 49 (0–441) mL/kg/min); LPA diameter: (pre – 2.4 (1.9–3.8) mm, post – 2.6 (1.9–3.4) mm); LPA flow: (pre – 112 (59–255), post – 122 (58–188) mL/kg/min. There were 3 out of 20 infants who developed PH at the post-natal age of 2, 11 and 16 days after extubation. Ductal and LPA flow did not change significantly after extubation in infants with or without PH irrespective of the ductal status.

Conclusions

Early extubation was not associated with a significant change from baseline in ductal and pulmonary flow in extremely preterm infants.

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