Am J Perinatol
DOI: 10.1055/s-0041-1736130
Original Article

Complicated Intubations are Associated with Bronchopulmonary Dysplasia in Very Low Birth Weight Infants

Tara Glenn
1  Department of Pediatrics, Division of Neonatology, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
2  Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
,
Linnea Fischer
2  Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
,
Ashley Markowski
1  Department of Pediatrics, Division of Neonatology, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
,
Cara Beth Carr
1  Department of Pediatrics, Division of Neonatology, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
,
Sindhoosha Malay
2  Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
,
Anna Maria Hibbs
1  Department of Pediatrics, Division of Neonatology, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
2  Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
› Author Affiliations
Funding Study data were collected and managed by using Research electronic data capture tools (REDCap) hosted at University Hospitals funded by Clinical and Translational Science Collaborative (CTSC) grant support (UL1TR002548), and U.S. Department of Health and Human Services, National Institutes of Health, e National Heart, Lung, and Blood Institute (K24HL143291), PI: Dr. Anna Maria Hibbs.

Abstract

Objective This study aimed to evaluate the association between desaturation <60% (severe desaturation) during intubation and a total number of intubation attempts in the first week of life in very low birth weight (VLBW) infants with adverse long-term outcomes including bronchopulmonary dysplasia (BPD) and severe periventricular/intraventricular hemorrhage grade 3 or 4 (PIVH).

Study Design A retrospective chart review was performed on VLBW infants intubated in the neonatal intensive care unit during the first week of life between January 2017 and July 2020. Descriptive tables were generated for two outcomes including BPD and PIVH. Multivariable logistic regression was performed for each outcome including significant predictors that differed between groups with a p-value of <0.2.

Results A total of 146 patients were included. Patients with BPD or PIVH had a lower gestational age, and patients with BPD had a lower BW. Patients with BPD had a greater number of intubation attempts in the first week of life (4 vs. 3, p < 0.001). In multivariable logistic regression controlling for confounding variables, the odds developing BPD were higher for patients with increased cumulative number of intubation attempts in the first week of life (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.03–1.62, p = 0.029). Post hoc analyses revealed increased odds of developing BPD with increased number of intubation encounters in the first week of life (OR: 2.20, 95% CI: 1.04–4.82, p = 0.043). In this post hoc analysis including intubation encounters in the model; desaturation <60% during intubation in the first week of life was associated with increased odds of developing BPD (OR: 2.35, 95% CI: 1.02–5.63, p = 0.048).

Conclusion The odds of developing BPD for VLBW infants were higher with increased intubation attempts and intubation encounters. In a post hoc analysis, the odds of developing BPD were also higher with desaturation during intubation. Further research is needed to determine mechanisms of the relationship between complicated intubations and the development of BPD.

Key Points

  • Neonatal intubations often require multiple attempts.

  • Neonates frequently desaturate during intubation.

  • Intubation attempts are positively associated with BPD.

  • Severe desaturation may be positively associated with BPD.



Publication History

Received: 11 May 2021

Accepted: 15 July 2021

Publication Date:
09 September 2021 (online)

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA