The influencing factors of neonatal extubation failure: A systematic review and meta-analysis

Objective To assess risk factors for extubation failure in mechanically ventilated neonatal patients in the neonatal intensive care unit. Methods We conducted a systematic review and meta-analysis of the literature. Data are reported as pooled odds ratios for categorical variables and mean differences for continuous variables. Data were sourced from common databases. Results A total of 3152 studies were retrieved, 22 of which were included in this meta-analysis involving 4096 children. The risk factors identified were: male sex, low gestational age, low body weight, low 1-minute Apgar score and 5-minute Apgar score, airway abnormality, necrotizing enterocolitis, diaphragmatic paralysis, sternal closure delay, patent ductus arteriosus, low pH, highPaCO 2 , low PaO 2 , low PaO 2 /FiO 2 , low white blood cell count, high heart rate, prolonged length of MV, inhaled nitric oxide and prolonged length of stay in the NICU. Subgroup analysis showed distinct risk factors for extubation failure among preterm, term, surgical, and non-surgical neonates. Within 48 or 72 hours of extubation, risk factors mostly overlapped, highlighting the need for tailored extubation strategies. Conclusions We identified 20 factors associated with an increased risk of extubation failure, which can help medical staff in the early identification of children with high risk of extubation failure and thereby take measures. Future studies could develop more accurate predictive models based on these factors to predict extubation outcomes in neonatal.