for neonatal and paediatric healthcare professionals

CLINICAL CASE STUDY | VOLUME 21 ISSUE 4/AUGUST 2025

Failed extubation in preterm infants: outcome and predictors

Extubation failure is common in extreme preterm infants and prediction of successful extubation is limited. This presentation is of the post-hoc analysis of prospectively collected data from a randomised trial to identify risk factors and outcome associated with unsuccessful extubation in preterm infants less than 32 weeks.

Dr Prashant Mallya¹

Dr Prakash Kannan Loganathan^1,2
(ORCID: 0000-0003-3717-8569)
pkannanloganathan@nhs.net

Professor Samir Gupta^3,4

¹Neonatal Unit, James Cook University Hospital, Middlesbrough
²Clinical Academic Office, Faculty of Medical Sciences, Newcastle University
³University of Durham
⁴Division of Neonatology, Sidra Medicine, Doha, Qatar

Mallya P., Loganathan P.K., Gupta S. Failed extubation in preterm infants: outcome and predictors. Infant 2025; 21(4): 112-16.

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Keywords

bronchopulmonary dysplasia; mechanical ventilation; extubation; minute ventilation test; preterm

Key points

Mechanical ventilation has been associated with adverse outcomes like bronchopulmonary dysplasia.
Up to 50% of extreme preterm infants fail extubation and predictive tools have limited value.
In our study, lower oxygen at the time of extubation (FiO₂) and higher birth weight predicted successful extubation.
Duration of mechanical ventilation and not reintubation episodes, was found to be significantly associated with poor outcome.

Also published in Infant:

VOLUME 21 ISSUE 5/OCTOBER 2025

LISA journey and experience at MMUH’s local neonatal unit

This article outlines the provision of less invasive surfactant administration (LISA) at Midland Metropolitan University Hospital’s (MMUH) local neonatal unit. The procedure is associated with a reduction in bronchopulmonary dysplasia and the number of days that an infant is mechanically ventilated, compared to the previous conventional way of administrating surfactant while infants were ventilated or via the INSURE technique.¹ The hospital’s LISA guidelines have been revised for a local edition, where pre-medication (sedation) has been replaced by non-pharmacological techniques such as cuddle and wrap, as well as sucrose. Fentanyl might cause respiratory depression and chest wall rigidity, ending with a requirement for positive pressure ventilation and intubation.² Only approximately 30% of neonatal units in the UK use sedation such as fentanyl or other opioids.³ After the guidelines were approved,⁴ staff were trained through simulation and the LISA procedure has now become routine.

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