Int J Clin Pediatr

International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access

Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc

Journal website https://www.theijcp.org

Original Article

Volume 13, Number 3, December 2024, pages 86-95

Weaning From Mechanical Ventilation in Preterm Newborns: Ventilatory Profile and the Construction of an Extubation Protocol

Figure 1. Sample selection process. Source: survey data. IMV: invasive mechanical ventilation; FPIC: free, prior and informed consent; PTNB: preterm newborn.

Figure 2. Protocol: weaning and extubation flowchart. SBT: spontaneous breathing test; HR: heart rate; SAB: Silverman-Andersen Bulletin; IP: inspiratory pressure; PEEP: positive end-expiratory pressure; RR: respiratory rate; FiO₂: fraction of inspired oxygen; MAP: mean airway pressure; ETCPAP: endotracheal continuous positive airway pressure; IMV: invasive mechanical ventilation; NIV: noninvasive ventilation; CPAP: continuous positive airway pressure.

Figure 3. Extubation checklist. IMV: invasive mechanical ventilation; SAB: Silverman-Andersen Bulletin; NIPS: Neonatal Infant Pain Scale; CPAP: continuous positive airway pressure.

**Table 1.** Characteristics of Premature Newborns at Centro Materno Infantil de Contagem, Contagem/Minas Gerais (From August 2021 to January 2022)
Variable	N = 27
Data were presented in absolute frequency and percentage, n represents the sample and % the relative frequency (%) or ^amedian, minimum and maximum. Apgar: appearance, pulse, grimace, activity, and respiration.
Gender (n, %)
Male	12 (44,4%)
Female	15 (55,6%)
Type of delivery (n, %)
Natural/vaginal	11 (40,7%)
Cesarean section	16 (59,3%)
Antenatal corticosteroid (n, %)
Yes	17 (63,0%)
No	10 (37,0%)
Gestational age (n, %)
Extremely premature (< 28 weeks)	7 (25,9%)
Moderately premature (28 to 31 weeks and 6 days)	14 (51,9%)
Late premature (32 to 36 weeks + 6 days)	6 (22,2%)
Weight at birth (n, %)
Extremely low weight (less than 1,000 g)	10 (37,0%)
Very low weight (1,000 to 1,499 g)	10 (37,0%)
Low weight (1,500 to 2,499 g)	5 (18,5%)
Over 2,500 g	2 (7,4%)
Apgar score (median, minimum and maximum^a)
Apgar - 1st min	8 (0 - 9)
Apgar - 5th min	9 (0 - 10)

Table 1. Characteristics of Premature Newborns at Centro Materno Infantil de Contagem, Contagem/Minas Gerais (From August 2021 to January 2022)

Variable

N = 27

Data were presented in absolute frequency and percentage, n represents the sample and % the relative frequency (%) or ^amedian, minimum and maximum. Apgar: appearance, pulse, grimace, activity, and respiration.

Gender (n, %)

Male

12 (44,4%)

Female

15 (55,6%)

Type of delivery (n, %)

Natural/vaginal

11 (40,7%)

Cesarean section

16 (59,3%)

Antenatal corticosteroid (n, %)

Yes

17 (63,0%)

10 (37,0%)

Gestational age (n, %)

Extremely premature (< 28 weeks)

7 (25,9%)

Moderately premature (28 to 31 weeks and 6 days)

14 (51,9%)

Late premature (32 to 36 weeks + 6 days)

6 (22,2%)

Weight at birth (n, %)

Extremely low weight (less than 1,000 g)

10 (37,0%)

Very low weight (1,000 to 1,499 g)

10 (37,0%)

Low weight (1,500 to 2,499 g)

5 (18,5%)

Over 2,500 g

2 (7,4%)

Apgar score (median, minimum and maximum^a)

Apgar - 1st min

8 (0 - 9)

Apgar - 5th min

9 (0 - 10)

**Table 2.** Ventilatory and Laboratory Parameters Evaluated Before Extubation at the Centro Materno Infantil de Contagem, Contagem/Minas Gerais (From August 2021 to January 2022)
Variable	N = 43
Data were presented in frequency and percentage (n, %) or ^amedian, minimum and maximum. TCPL: pressure-limited time-cycled ventilation; PCV: pressure-controlled ventilation; IP: inspiratory pressure; PEEP: positive end-expiratory pressure; RR: respiratory rate; FiO₂: fraction of inspired oxygen; MAP: mean airway pressure.
Type of mechanical ventilation, n (%)
TCPL	42 (97.7%)
PCV	1 (2.3%)
Ventilatory parameters (median, minimum - maximum)^a
IP	15 (12 - 17)
PEEP	6 (5 - 7)
RR	30 (24 - 36)
FiO₂	30 (21 - 50)
MAP evaluation, n (%)
Yes	13 (30.2%)
No	30 (69.8%)
Arterial blood gases, n (%)
Yes	26 (60.5%)
No	17 (39.5%)
Pulmonary X-ray, n (%)
Yes	22 (51.2%)
No	21 (48.8%)
Drug intervention, n (%)
Yes	13 (30.2%)
No	30 (69.8%)

Table 2. Ventilatory and Laboratory Parameters Evaluated Before Extubation at the Centro Materno Infantil de Contagem, Contagem/Minas Gerais (From August 2021 to January 2022)

Variable

N = 43

Data were presented in frequency and percentage (n, %) or ^amedian, minimum and maximum. TCPL: pressure-limited time-cycled ventilation; PCV: pressure-controlled ventilation; IP: inspiratory pressure; PEEP: positive end-expiratory pressure; RR: respiratory rate; FiO₂: fraction of inspired oxygen; MAP: mean airway pressure.

Type of mechanical ventilation, n (%)

TCPL

42 (97.7%)

PCV

1 (2.3%)

Ventilatory parameters (median, minimum - maximum)^a

15 (12 - 17)

PEEP

6 (5 - 7)

30 (24 - 36)

FiO₂

30 (21 - 50)

MAP evaluation, n (%)

Yes

13 (30.2%)

30 (69.8%)

Arterial blood gases, n (%)

Yes

26 (60.5%)

17 (39.5%)

Pulmonary X-ray, n (%)

Yes

22 (51.2%)

21 (48.8%)

Drug intervention, n (%)

Yes

13 (30.2%)

30 (69.8%)

**Table 3.** Evaluation of the Extubation Outcome in Relation to Ventilatory Support, Medication and Clinical Variables of PTNBs from the Centro Materno Infantil de Contagem (From August 2021 to January 2022)
	Assessment of extubation events (n = 43)
Data were presented in frequency and percentage. NIV: noninvasive ventilation; CPAP: continuous positive airway pressure; Apgar: appearance, pulse, grimace, activity, and respiration.
Ventilatory support, n (%)
NIV	4 (80.0)	16 (72.2)	0 (0.0)	5 (100.0)	2 (100.0)	3 (100.0)
CPAP	1 (20.0)	5 (23.8)	4 (57.1)	0 (0.0)	0 (0.0)	0 (0.0)
Ambient air	0 (0.0)	0 (0.0)	3 (42.9)	0 (0.0)	0 (0.0)	0 (0.0)
Presence of stridor, n (%)	0 (0.0)	2 (9.5)	1 (14.3)	5 (100.0)	2 (100.0)	2 (66.7)
Post-extubation micronebulization	0 (0.0)	3 (14.3)	1 (14.3)	0 (0.0)	0 (0.0)	2 (66.7)
Drug intervention	2 (40.0)	8 (38.1)	0 (0.0)	1 (20.0)	0 (0.0)	2 (66.7)
Pre-extubation 5th min Apgar up to 3 points at birth	0 (0.0)	0 (0.0)	1 (14.3)	0 (0.0)	0 (0.0)	0 (0.0)

Table 3. Evaluation of the Extubation Outcome in Relation to Ventilatory Support, Medication and Clinical Variables of PTNBs from the Centro Materno Infantil de Contagem (From August 2021 to January 2022)

Assessment of extubation events (n = 43)

Events with successful extubation (n = 33)

Events with failed extubation (n = 10)

Extreme (n = 5)

Moderate (n = 21)

Late (n = 7)

Extremes (n = 5)

Moderate (n = 2)

Later (n = 3)

Data were presented in frequency and percentage. NIV: noninvasive ventilation; CPAP: continuous positive airway pressure; Apgar: appearance, pulse, grimace, activity, and respiration.

Ventilatory support, n (%)

NIV

4 (80.0)

16 (72.2)

0 (0.0)

5 (100.0)

2 (100.0)

3 (100.0)

CPAP

1 (20.0)

5 (23.8)

4 (57.1)

0 (0.0)

Ambient air

0 (0.0)

3 (42.9)

0 (0.0)

Presence of stridor, n (%)

0 (0.0)

2 (9.5)

1 (14.3)

5 (100.0)

2 (100.0)

2 (66.7)

Post-extubation micronebulization

0 (0.0)

3 (14.3)

1 (14.3)

0 (0.0)

2 (66.7)

Drug intervention

2 (40.0)

8 (38.1)

0 (0.0)

1 (20.0)

0 (0.0)

2 (66.7)

Pre-extubation 5th min Apgar up to 3 points at birth

0 (0.0)

1 (14.3)

0 (0.0)

**Table 4.** Extubation Failure Rates According to Age and Birth Weight at Centro Materno Infantil de Contagem - Contagem/Minas Gerais (From August 2021 to January 2022 (N = 43))
Variable	Failure rate (%)
Extubation failure rate (reintubations within 48 h): total number of extubation failures divided by the total number of extubations × 100 (From August to January 2022).
General fee	23.3%
Gestational age
Extremely premature (< 28 weeks)	50%
Moderately premature (28 to 31 weeks and 6 days)	8.7%
Late premature (32 to 36 weeks + 6 days)	30%
Birth weight
Extremely low weight (less than 1,000 g)	33.3%
Very low weight (1,000 to 1,499 g)	21.4%
Low weight (1,500 to 2,499 g)	0%
Over 2,500 g	0%

Table 4. Extubation Failure Rates According to Age and Birth Weight at Centro Materno Infantil de Contagem - Contagem/Minas Gerais (From August 2021 to January 2022 (N = 43))

Variable

Failure rate (%)

Extubation failure rate (reintubations within 48 h): total number of extubation failures divided by the total number of extubations × 100 (From August to January 2022).

General fee

23.3%

Gestational age

Extremely premature (< 28 weeks)

50%

Moderately premature (28 to 31 weeks and 6 days)

8.7%

Late premature (32 to 36 weeks + 6 days)

30%

Birth weight

Extremely low weight (less than 1,000 g)

33.3%

Very low weight (1,000 to 1,499 g)

21.4%

Low weight (1,500 to 2,499 g)

Over 2,500 g