Environmental factors contribute to the success of extubation in newborns: A multicenter cross-sectional study

Abstract

Introduction

Newborns (NB) undergoing invasive mechanical ventilation (IMV) should be extubated as early as possible. Predictive factors for successful extubation are often considered in isolation, focusing on personal factors and the functions and structures of the NB's body, according to the International Classification of Functioning, Disability and Health (ICF).

Objectives

To assess the contribution of ICF components to the successful extubation of NB.

Method

A multicenter, observational and retrospective study was conducted using medical records of NB from five macroregions of Brazil. NB who underwent IMV of >24 h were included. Clinical and sociodemographic variables were organized according to ICF components, and factors associated with successful extubation were analyzed using a generalized linear model.

Results

A total of 498 NB were included, with an extubation success rate of 82.3 %. The body functions and structures component included pH (p = 0.006), the environmental factors component included the number of prenatal consultations (p = 0.002) and mode of ventilation (p = 0.004), and the personal factors component included gestational age (p < 0.001), birth weight (p < 0.001), gestational age at extubation (p < 0.001), and weight at extubation (p < 0.001). Environmental factors increased the probability of successful extubation by 1.72 times (95 % CI: 1.26, 2.35).

Conclusion

The environmental factors component of the ICF significantly influenced extubation outcomes in NB, increasing the probability of success. These findings highlight the importance of developing extubation protocols that integrate predictive variables from all ICF components, considering both functional and structural alterations along with contextual factors.