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Peri-extubation settings in preterm neonates: a systematic review and meta-analysis

Journal of Perinatology volume 44, pages 257–265 (2024)Cite this article

Subjects

Abstract

Objective

To systematically review: 1) peri-extubation settings; and 2) association between peri-extubation settings and outcomes in preterm neonates.

Study Design

In this systematic review, studies were eligible if they reported patient-data on peri-extubation settings (objective 1) and/or evaluated peri-extubation levels in relation to clinical outcomes (objective 2). Data were meta-analyzed when appropriate using random-effects model.

Results

Of 9681 titles, 376 full-texts were reviewed and 101 included. The pooled means of peri-extubation settings were summarized. For objective 2, three experimental studies were identified comparing post-extubation CPAP levels. Meta-analyses revealed lower odds for treatment failure [pooled OR 0.46 (95% CI 0.27–0.76); 3 studies, 255 participants] but not for re-intubation [pooled OR 0.66 (0.22–1.97); 3 studies, 255 participants] with higher vs. lower CPAP.

Conclusions

Summary of peri-extubation settings may guide clinicians in their own practices. Higher CPAP levels may reduce extubation failure, but more data on peri-extubation settings that optimize outcomes are needed.

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Fig. 1: PRISMA Diagram.
Fig. 2: Forest plots of meta-analyses of outcomes for Higher vs. Lower post-extubation CPAP.

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Data availability

Data extracted from eligible studies used to generate summaries are provided in the Supplementary File (Table S.9). Additional data are available from authors upon request.

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Funding

None specific to this study. Dr. Amit Mukerji is supported by a Research Early Career Award from Hamilton Health Sciences Foundation (2019-2024).

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Authors and Affiliations

  1. Department of Pediatrics, McMaster University, Hamilton, ON, Canada

    Yogesha K. Nagaraj & Amit Mukerji

  2. Department of Pediatrics, Suhar Hospital, Suhar, Oman

    Said Al Balushi

  3. Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Courtney Robb & Nikhil Uppal

  4. Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Sourabh Dutta

Authors
  1. Yogesha K. Nagaraj
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  2. Said Al Balushi
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  3. Courtney Robb
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  4. Nikhil Uppal
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  5. Sourabh Dutta
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  6. Amit Mukerji
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Contributions

Each listed author has met criteria for authorship requirements. AM devised the study concept. YN, SA, CR and NU performed study related data acquisition. YN and AM conducted the analyses. SD provided methodological feedback, including during analyses of data. YN and AM drafted the manuscript and all named authors provided revisions to and approved the final version of the manuscript.

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Correspondence to Amit Mukerji.

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Nagaraj, Y.K., Balushi, S.A., Robb, C. et al. Peri-extubation settings in preterm neonates: a systematic review and meta-analysis. J Perinatol 44, 257–265 (2024). https://doi.org/10.1038/s41372-024-01870-1

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  • DOI: https://doi.org/10.1038/s41372-024-01870-1

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