Objective To quantify the extubation failure rate among VLBW infants and describe characteristics of those who failed.

Methods A retrospective review was performed between 2005 and 2006. VLBW infants <32 weeks requiring mechanical ventilation at <48 hours of life were included. Exclusion criteria included severe congenital pulmonary or cardiac abnormality or withdrawal of care. Background data on infant characteristics were recorded. A diagnosis of extubation failure was made if infants were reventilated within 48 hours. Normal data were analysed using t-tests and non-parametric data using the Mann–Whitney test.

Results 145 eligible infants were identified. 21% (n = 31) required reintubation within the first 48 hours. 98% of infants had caffeine, 96% received CPAP. Infants who failed extubation were smaller (0.93 v 0.85 kg), less mature (28.3 v 26.8 wks) and had a lower pH (7.36 v 7.3) and higher pCO₂ (5.4 v6.2) pre extubation (all p<0.05). Extubation failure was unaffected by gender, antenatal steroid use or co-morbidities. Severe apnoea was the commonest reason for reintubation (40%). Other clinical indications included hypercarbia and increased work of breathing. The average duration of mechanical ventilation before extubation was 195 hours in infants who failed and 104 hours in those who were successfully extubated. The average time to reintubation was 4 hours in those who failed.

Conclusions This study found a 21% reintubation rate among extubated VLBW infants. Infants who failed extubation were of lower gestational age and birth weight and had worse blood gas results pre and post extubation.