Background Mechanical ventilation is a cornerstone of managing respiratory failure in preterm infants. Whilst its role to improve the survival rate has been proven, it can also result in unintended harm.^{1 2}

It can increase the risk of developing bronchopulmonary dysplasia, sepsis, neurological injury, and retinopathy of prematurity. Because of that, clinicians aim to extubate preterm infants as early as possible. ^{3 4}

Given that approximately two-thirds of infants born before 29 weeks’ gestation require intubation, an extubation checklist was implemented at the neonatal intensive care unit at Leeds General Infirmary hospital and St James hospital trying to improve the successful extubation rate.

Objectives To identify if using the extubation checklist has helped to reduce the rate of unsuccessful extubation in preterm infants in neonatal units at Leeds general infirmary hospital and St James hospital.

Methods

• A retrospective cohort study of extremely preterm infants (<27 weeks gestational age) or ELBW infants (birth weight <1000 g) requiring mechanical ventilation during the period 01/01 – 30/06 in 2013 and 2018 (pre and post-implementation of the extubation list).

• Successful extubation is defined as not requiring reintubation for 72 hours post-extubation.

• Badger system was used to search for all patients who were admitted to LGI & St James neonatal unites during the 2 periods of 01/01/2013 – 30/06/2013 and 01/01/2018 - 30/06/2018.

• Notes for the identified patients were requested from the archive.

• Dates of extubation and re-intubation attempts were obtained from the notes

Inclusive criteria

• <27 weeks gestational age and/or birthweight <1000 grams

• Born between 01/01/2013 – 30/06/2013 and 01/01/2018–30/06/2018

• Required mechanical ventilation during the same period.

• The use of the extubation checklist in 2018 group

Results Amongst the pre-checklist cohort, 24 babies met the GA/BW criteria, with 3 sets of notes unavailable. Of these, 15 patients received mechanical ventilation. There were 27 extubation attempts, 19 of these were unsuccessful and 8 of them were successful (29.6%).

In 2018, 31 babies met the GA/BW criteria, with 4 sets of notes unavailable, 17 patients needed ventilation, 30 extubation attempts using the extubation checklist, 16 of these were unsuccessful and 14 of them were successful (46.6%)

Conclusions

• It was noted that the proportion of unsuccessful extubation attempts dropped by 17% (from 70.4% to 53.4%) after implementing the extubation checklist.

• Extubation of extreme preterms is 1.6 more likely to be successful when extubation checklist is used.