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          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Predictors of successful extubation &#40;OR&#60;1&#41; and failed extubation &#40;OR&#62;1&#41;&#46; FiO<span class="elsevierStyleInf">2</span>&#44; fraction of inspired oxygen&#59; GA&#44; gestational age&#59; GDM&#44; gestational diabetes mellitus&#59; PCO<span class="elsevierStyleInf">2</span>&#44; partial pressure of carbon dioxide&#59; PIH&#44; pregnancy-induced hypertension&#59; SGA&#44; small for gestational age Note&#58; PCO<span class="elsevierStyleInf">2</span>&#44; FiO<span class="elsevierStyleInf">2</span> were in-transformed&#59; <span class="elsevierStyleItalic">P</span> value was calculated by generalized linear model&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0005" class="elsevierStylePara elsevierViewall">Preterm birth rates are increasing&#44; with more than one million preterm infants born annually in China&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> The greatest increase is in extremely and very preterm infants&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> A longer cumulative duration of mechanical ventilation among very preterm infants is associated with high rates of mortality and morbidities&#44; including ventilator-associated pneumonia&#44; diaphragmatic atrophy&#44; pneumothorax&#44; and bronchopulmonary dysplasia &#40;BPD&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0003"><span class="elsevierStyleSup">3&#8211;7</span></a> Delayed weaning can also increase the risk of severe intracranial hemorrhage and delayed sepsis&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Weaning from the ventilator as soon as possible and shortening the duration of invasive mechanical ventilation is the current consensus in clinical practice&#46; This goal may be achieved using non-invasive respiratory support and&#44; among intubated infants&#44; by reducing the duration of mechanical ventilation by conducting successful extubation as early as possible&#46; Weaning from a ventilator in preterm neonates is a variable and inconsistent process among centers and clinicians who have limited ability to predict extubation readiness&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0006" class="elsevierStylePara elsevierViewall">Extubation failure has been independently associated with increased mortality&#44; longer hospitalization&#44; and more days of receiving oxygen and ventilatory support&#46;<a class="elsevierStyleCrossRefs" href="#bib0009"><span class="elsevierStyleSup">9&#8211;12</span></a> It is therefore critical to attempt extubation early and at a time when success is likely&#46; Identifying factors associated with successful extubation may help reduce the duration of mechanical ventilation&#44; improve outcomes&#44; and help to design future research studies in ventilated preterm infants&#46; However&#44; extubation failure will occur in some preterm infants&#44; often secondary to apnea&#44; atelectasis&#44; or intercurrent illness&#46; Very preterm infants are at higher risk of extubation failure than mature infants&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall">Existing research reports the risk factors for extubation failure among extremely premature infants as&#58; lower gestational age&#44; a lower five-minute Apgar score&#44; lower pH prior to extubation&#44; a higher peak fraction of inspired oxygen&#44; higher partial pressure of carbon dioxide &#40;PCO<span class="elsevierStyleInf">2</span>&#41;&#44; a higher fraction of inspired oxygen prior to extubation&#44; and small for gestational age status &#40;SGA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> However&#44; previous studies have not proposed cut-off values of independent risk factors for extubation failure&#44; and few studies have examined the impact of failed extubation on extremely and very preterm infants in China&#46;</p><p id="para0008" class="elsevierStylePara elsevierViewall">To address these research gaps this study aimed to explore the clinical or sociodemographic predictors for both successful and failed extubation among extremely and very preterm infants&#44; and to identify the cut-off points of significant predictors&#46; The hypotheses of this study are&#58; &#40;1&#41; What are the predicting factors of successful extubation&#63; &#40;2&#41; What are the predicting factors of failed extubation&#44; and the cut-off values of predicting factors for failed extubation&#63;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Study design</span><p id="para0009" class="elsevierStylePara elsevierViewall">This was a retrospective cohort study of extremely and very preterm infants intubated within 24&#160;h of birth from 2016 to 2020 at Guangzhou Women and Children&#39;s Medical Centre&#44; which has four Neonatal Intensive Care Units &#40;NICUs&#41;&#46; The human research ethics committee of Guangzhou Women and Children&#39;s Medical Centre approved this retrospective cohort study &#40;SFRKLTZ2020D03300&#41;&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Operational definitions</span><p id="para0010" class="elsevierStylePara elsevierViewall">The criteria for intubation&#44; extubation&#44; and reintubation were as follows&#46; Infants could be intubated if they met any of the following&#58; fraction of inspired oxygen &#40;FiO<span class="elsevierStyleInf">2</span>&#41; &#62; 0&#46;60 required to maintain oxygen saturation at or above 85&#37; using pulse oximeter&#59; PCO<span class="elsevierStyleInf">2</span> &#62; 65&#160;mm Hg&#44; pH &#60; 7&#46;2&#59; or hemodynamic instability&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> Intubation could also be performed at any time for repetitive apnea requiring positive pressure ventilation&#44; clinical shock&#44; sepsis&#44; or the need for surgery&#46; Extubation was to be attempted if the infant met all of the following criteria&#58; PCO<span class="elsevierStyleInf">2</span> &#60; 65&#160;mm Hg&#44; pH &#62; 7&#46;20&#59; oxygen saturation &#8805; 88&#37; &#40;extubation can be considered when oxygen saturation reaches 88&#37; or higher&#41;&#59; FiO<span class="elsevierStyleInf">2</span> &#8804; 0&#46;50&#59; mean airway pressure &#60; 10&#160;cm H<span class="elsevierStyleInf">2</span>O&#59; a ventilator rate of &#8804; 20 breaths per minute&#59; an amplitude of less than twice the mean airway pressure if high-frequency oscillatory ventilation was being used&#59; hemodynamic stability&#59; and the absence of clinically significant patent ductus arteriosus&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> The infants were extubated in a model of non-invasive respiratory support by continuous positive airway pressure &#40;CPAP&#41;&#44; or non-invasive positive pressure ventilation &#40;NIPPV&#41;&#46; The criteria for reintubation were the same as those for initial intubation&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Sample size calculation</span><p id="para0011" class="elsevierStylePara elsevierViewall">As this is a retrospective cohort study&#44; the authors calculated the sample size post-hoc&#46; The authors calculated the performance of each variable related to extubation failure based on the existing sample size and found that the statistical power was greater than 0&#46;8&#44; indicating the sample size of 385 to be sufficient&#46; The authors used an event per variable &#40;EPV&#41; method to estimate the sample size required for the final multivariate logistic regression &#8211; with the EPV equal to 10&#44; the final model was controlled to include eight variables at most&#46; With a missing rate of 10&#37;&#44; the number of patients with extubation failure in the study was at least 88&#46; In this study the extubation failure in the present study&#39;s sample was 110&#44; indicating that the sample size of this study is sufficient&#46;</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Study participants</span><p id="para0012" class="elsevierStylePara elsevierViewall">Infants were eligible if they had a gestational age &#40;GA&#41; of under 32 weeks&#44; had been receiving mechanical ventilation through an endotracheal tube within 24&#160;h of birth&#44; and were scheduled to undergo extubation for the first time with &#8220;non-invasive&#8221; respiratory support in one of four NICUs of a regional children&#39;s medical centre in southern China&#46; Infants were ineligible if they had a known major congenital anomaly that might affect breathing&#44; or if they were intentionally stopped active treatment at NICU by parents&#46; All subjects with pulmonary hypoplasia were excluded from this study&#46;</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Outcome measures</span><p id="para0013" class="elsevierStylePara elsevierViewall">The primary outcome was successful extubation for longer than three days&#46; Secondary outcomes were BPD&#44; death&#44; BPD&#47;death&#44; retinopathy of prematurity &#40;ROP&#41;&#44; severe ROP &#40;defined as needing surgery&#41;&#44; necrotizing enterocolitis&#44; severe necrotizing enterocolitis &#40;defined as needing surgery&#41;&#44; ligation of patent ductus arteriosus &#40;PDA&#41;&#44; intracranial hemorrhage &#40;ICH&#41;&#44; days on mechanical ventilation&#44; and increased length of hospital stay among survivors&#46; BPD was defined as the use of supplemental oxygen at 36 weeks postmenstrual age &#40;PMA&#41; or at discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Infants receiving high&#47;low flow nasal cannula of 21&#37; at 36 weeks were corrected by gestational age and labeled as BPD&#46; Successful extubation was defined as survival without the need for respiratory support with an endotracheal tube for more than three days&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> Extubation failure was defined as the need for reintubation for any reason within 72&#160;h following extubation&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Hence&#44; this study defined extubation success or failure as occurring up to three days following extubation&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> Increasingly&#44; studies define reintubation within three days after extubation as extubation failure<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> as this captures most clinical information regarding extubation failure and avoids the inclusion of new pathogenic factors in the reasons for extubation failure&#46;</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Data collection</span><p id="para0014" class="elsevierStylePara elsevierViewall">Detailed data were collected on baseline characteristics&#58; gestational age&#44; birth weight&#44; sex&#44; mode of delivery&#44; small for gestational age &#40;SGA&#41;&#44; Apgar score at five minutes after birth&#44; prolonged premature rupture of membranes &#40;&#62; 18&#160;h&#41;&#44; multiple births&#44; maternal age&#44; hypertensive disorders in pregnancy&#44; gestational diabetes mellitus&#44; maternal fever at one week before delivery&#44; antenatal steroids administration&#44; and resuscitation in the delivery room&#46; Peri-extubation characteristics were collected&#44; including surfactant treatment&#44; caffeine treatment&#44; ventilator support &#40;FiO<span class="elsevierStyleInf">2</span>&#44; pH&#44; PCO<span class="elsevierStyleInf">2</span>&#44; lactic acid prior to extubation&#41;&#44; and age at extubation&#46;</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Statistical analyses</span><p id="para0015" class="elsevierStylePara elsevierViewall">To study the incidence and predictors of successful extubation&#44; the authors grouped infants according to whether the first extubation was successful&#46; The authors compared perinatal and peri-extubation characteristics of failed and successful infant extubation&#46; Categorical characteristics were compared between the two groups using a chi-square test and continuous characteristics were analyzed using t-tests&#46; For characteristics that did not follow the normal distribution&#44; the authors used logarithmic transformation to adjust their distribution&#46; Stepwise multivariate regression was used to determine factors associated with successful extubation&#46; To avoid collinearity in the multivariate model&#44; the authors screened the independent variables in advance &#40;using stepwise regression&#41; to determine the independent risk factors of extubation failure &#40;<span class="elsevierStyleItalic">p</span> values of &#60; 0&#46;05 in bivariate tests&#41;&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">The authors also used the Restricted Cubic Spline regression to analyze the trend of independent risk factors and to explore whether there was a potential nonlinear correlation and critical point between extubation failure and the risk factors&#46; Infants in the successful and failed extubation groups were compared for neonatal morbidities&#44; as outlined above in the secondary outcomes&#46;</p></span></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Results</span><p id="para0017" class="elsevierStylePara elsevierViewall">A total of 385 extremely and very preterm infants were intubated in the first 24&#160;h after birth&#46; Among these&#44; 26 infants were excluded &#40;six infants had major congenital malformations&#44; and 20 infants were not given active treatment at NICU by their parents&#41;&#46; Thus&#44; 359 infants were included in the retrospective study&#46; Of these 359 infants&#44; there were 249 &#40;69&#46;4&#37;&#41; successful extubation cases and 110 &#40;30&#46;6&#37;&#41; failed cases&#46;</p><p id="para0018" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#44; infants in the failed extubation group had lower birth weight&#44; with a mean of 1075&#46;90 g &#40;SD&#160;&#61;&#160;283&#46;58&#41;&#59; lower gestational age&#44; with a mean of 27&#46;98 weeks &#40;SD&#160;&#61;&#160;1&#46;71&#41;&#59; and higher pre-extubation FiO<span class="elsevierStyleInf">2</span> rates of 40&#37;&#46; Infants in the failed extubation group were more likely to have been intubated in the delivery room&#59; had lower pre-extubation pH&#44; with a mean of 7&#46;32 &#40;SD&#160;&#61;&#160;0&#46;18&#41;&#59; had higher pre-extubation PCO<span class="elsevierStyleInf">2</span> &#40;with 6&#46;30&#160;kPa&#41; and higher amounts of pre-extubation lactic acid &#40;equalling 2&#46;4&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0019" class="elsevierStylePara elsevierViewall">Generalized linear regression analysis in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a> shows the following were associated with successful extubation&#58; higher birth weight&#44; higher gestational age &#40;GA&#41;&#44; a cesarean section delivery&#44; a higher five-minute Apgar score&#44; and higher pH prior to extubation&#46; Higher FiO<span class="elsevierStyleInf">2</span> and higher PCO<span class="elsevierStyleInf">2</span> prior to extubation were associated with failed extubation after the stepwise multivariate regression was conducted &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0020" class="elsevierStylePara elsevierViewall">Failed extubation was associated with older mothers&#44; infants intubated in the delivery room&#44; higher FiO<span class="elsevierStyleInf">2</span> prior to extubation&#44; higher PCO<span class="elsevierStyleInf">2</span> prior to extubation&#44; higher amounts of lactic acid&#44; and greater age at extubation &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Figure 1</a>&#41;&#46; The cut-off values of the independent risk factors were pH&#160;&#61;&#160;7&#46;38&#44; and age at extubation&#160;&#61;&#160;two days&#44; respectively&#46; If the pH was lower than 7&#46;38&#44; or the age at extubation was greater than two days&#44; the extubation failure rate was higher &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0021" class="elsevierStylePara elsevierViewall">As shown in Appendix &#40;Supplementary Material&#41;&#44; the risk of BPD in the failed extubation group was 2&#46;753 times higher than that of the successful extubation group&#46; The risk of death before discharge in the failed extubation group was 14&#46;058 times higher than that of the successful extubation group&#46; The risk of BPD&#47;death in the failed extubation group was 12&#46;304 times higher than that of the successful extubation group&#46; The risk of ROP in the failed extubation group was 1&#46;774 times higher than that of the successful extubation group&#46; The risk of severe ROP in the failed extubation group was 4&#46;037 times higher than that of the successful extubation group&#46; The risk of PDA ligation in the failed extubation group was 4&#46;349 times higher than that of the successful extubation group&#46; The adjustment factors were gestational age&#44; pre-extubation pH&#44; pre-extubation PCO<span class="elsevierStyleInf">2</span>&#44; pre-extubation FiO<span class="elsevierStyleInf">2</span>&#44; and age at extubation&#46; Of the survivors&#44; infants in the failed extubation group had longer hospital stays and spent more days on mechanical ventilation compared with those in the successful extubation group &#40;Appendix&#41;&#46;</p></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Discussion</span><p id="para0022" class="elsevierStylePara elsevierViewall">In this retrospective cohort study of extremely and very preterm infants intubated within 24&#160;h after birth&#44; extubation success was predicted by higher gestational age&#44; higher pre-extubation pH&#44; lower FiO<span class="elsevierStyleInf">2</span> prior to extubation&#44; and lower pre-extubation PCO<span class="elsevierStyleInf">2</span>&#44; and lower age at extubation&#46; Infants in the present cohort study who experienced extubation failure were more likely to experience BPD and die before discharge from the hospital&#44; as well as needing prolonged mechanical ventilation and hospitalization&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">Preterm infants may fail extubation due to the increased work of breathing&#44; significant apnea and bradycardia&#44; low oxygen saturation&#44; respiratory acidosis&#44; and upper airway narrowing&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> The predictive value for extubation success among infants with higher GAs was expected&#46; Clinicians caring for extremely preterm infants are aware of the increased risk of extubation failure in immature infants compared with more mature infants&#46; In the original randomized trial<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> the rate of re-intubation was 32&#37; in extremely preterm infants&#44; compared with 7&#37; for very preterm infants&#46; Most clinicians also consider blood gas measurements&#44; including PCO<span class="elsevierStyleInf">2</span>&#44; before extubation<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> in the knowledge that mechanically ventilated infants with severe hypercapnia are unlikely to be able to generate adequate spontaneous tidal volumes to be successfully extubated&#46;</p><p id="para0024" class="elsevierStylePara elsevierViewall">Higher pre-extubation pH&#44; lower pre-extubation FiO<span class="elsevierStyleInf">2</span>&#44; and age at extubation independently predicted extubation success in the present study&#46; Consistent with previous research&#44; a higher pre-extubation pH&#44; higher five-minute Apgar scores&#44; and higher GA were associated with extubation success&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Further consistent with previous research&#44; age at extubation was a significant predictor of successful extubation&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> This study also found that if the age at extubation was greater than two days&#44; the extubation failure rate increased accordingly&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">The authors found in the univariate analysis that cesarean section deliveries&#44; older mothers&#44; and lower lactate pre-extubation were associated with extubation failure&#44; but no association was found in the multivariate analysis&#46; These results might be caused by collinearity&#59; they were not independent risk factors&#46; Additionally&#44; the authors found there was a nonlinear relationship between extubation failure&#44; age at extubation&#44; and carbon dioxide partial pressure&#46; The present data showed that when the pre-extubation pH was lower than 7&#46;38 and the age at extubation was greater than two days&#44; the risk of extubation failure would increase significantly&#46;</p><p id="para0026" class="elsevierStylePara elsevierViewall">At present&#44; research evidence provides limited guidance on extubation indicators&#46; Previous studies evaluating whether newborns should be extubated have focused on clinical symptoms and pulmonary function indicators&#46;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> The present study indicates that pH and age at extubation may be used as significant predictors of failed extubation and suggests cut-off values to judge extubation failure&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">Extubation failure has an adverse effect on the prognosis of newborns&#46; The authors found those very preterm infants who failed extubation had higher rates of neonatal morbidities&#44; including BPD&#44; death&#44; combined outcomes of BPD&#47;death&#44; ROP&#47;severe ROP&#44; and ligation of PDA&#46; Among survivors&#44; those in the failed extubation group spent longer on mechanical ventilation and had longer hospital stays compared with those in the successful extubation group&#46; The present study&#39;s results are consistent with studies by Manley et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> and Chawla et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Both these studies were conducted among extremely preterm infants born at less than 28 weeks gestational age and found that failed extubation was associated with BPD&#44; death&#44; longer hospital stays&#44; and ventilation courses&#46; Manley et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> also noted that extremely preterm infants who failed extubation were more likely to experience severe retinopathy of prematurity and PDA ligation&#46; Chawla et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> noted that extremely preterm infants who failed extubation were more likely to experience severe intracranial hemorrhages &#40;grade III&#47;IV&#41; and late-onset sepsis&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">Endotracheal reintubation is not an easy process&#46; Recent studies reported successful intubation rates of between 60&#37; and 73&#37; in preterm neonates&#44; as well as long periods of time &#40;51&#160;&#177;&#160;28&#160;s&#41; needed for intubation&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> Endotracheal intubation is associated with discomfort for the infant and may result in malposition of the tube&#44; trauma to the airway&#44; and hemodynamic instability&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a> Endotracheal intubations have also been associated with alterations in brain function&#44; as monitored by electroencephalography&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> Reintubation is associated with an increase in nosocomial pneumonia and high mortality&#44; and it is critical to identify effective intervention strategies for avoiding reintubation&#46;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a></p><p id="para0029" class="elsevierStylePara elsevierViewall">There are several limitations to this study&#46; It involved a retrospective cohort study of data with selection bias&#44; as the infants included in the analysis&#44; were cared for in one center&#46; Even though the authors adjusted for important and significant clinical variables&#44; there could have been unknown differences in the failed and successful extubation groups that may be associated with both failed extubation and neonatal morbidity&#46; The authors did not analyze the impact of different ventilator modes on extubation failure as the study focused only on initial extubation failure&#46; In clinical practice&#44; infants could have repeated intubation and extubation episodes&#46; A recent systematic review noted that prophylactic methylxanthines reduce the rate of extubation failure in premature infants&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> In the present study&#39;s analysis&#44; there was no statistical difference in the use of caffeine before extubation in either the successful or failed extubation groups&#46; Whether or not the association between extubation failure and morbidities such as BPD or death were related to the extubation procedure itself could not be determined from these data&#46; The cut-off values for predicting the failure of extubation obtained in this study are for reference only and need to be further confirmed by a large sample and multi-center study&#46; The failure extubation rate of 30&#37; was higher than in other studies&#44; and this may reflect the treatment status in the present study&#39;s center&#46; Finally&#44; as this is a retrospective cohort study&#44; the authors did not collect specific modality parameters for post-extubation respiratory support&#44; and therefore this study could not examine the effect of different modalities on extubation&#46;</p></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Conclusions</span><p id="para0030" class="elsevierStylePara elsevierViewall">This study found that higher GA&#44; higher pre-extubation pH&#44; lower pre-extubation FiO<span class="elsevierStyleInf">2</span> and PCO<span class="elsevierStyleInf">2</span>&#44; and lower age at extubation are significant predictors of successful extubation among extremely and very preterm infants&#46;</p></span></span>"
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              "titulo" => "Study participants"
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    "fechaRecibido" => "2022-01-31"
    "fechaAceptado" => "2022-04-13"
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Extremely and very preterm infants"
            1 => "Extubation"
            2 => "Predictors"
            3 => "Cohort studies"
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    "resumen" => array:1 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Objective</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">To explore the clinical or sociodemographic predictors for both successful and failed extubation among Chinese extremely and very preterm infants</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Methods</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study was carried out among extremely and very preterm infants born at less than 32 weeks of gestational age &#40;GA&#41;&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">Compared with the infants who experienced extubation failure&#44; the successful infants had higher birth weight &#40;OR 0&#46;997&#59; CI 0&#46;996&#8211;0&#46;998&#41;&#44; higher GA &#40;OR 0&#46;582&#59; 95&#37; CI 0&#46;499&#8211;0&#46;678&#41;&#44; a caesarean section delivery &#40;OR 0&#46;598&#59; 95&#37; CI 0&#46;380&#8211;0&#46;939&#41;&#44; a higher five-minute Apgar score &#40;OR 0&#46;501&#59; 95&#37; CI 0&#46;257&#8211;0&#46;977&#41;&#44; and a higher pH prior to extubation &#40;OR 0&#46;008&#59; 95&#37; CI 0&#46;001&#8211;0&#46;058&#41;&#46; Failed extubation was associated with older mothers &#40;OR 1&#46;055&#59; 95&#37; CI 1&#46;013&#8211;1&#46;099&#41;&#44; infants intubated in the delivery room &#40;OR 2&#46;820&#59; 95&#37; CI 1&#46;742&#8211;4&#46;563&#41;&#44; a higher fraction of inspired oxygen &#40;FiO<span class="elsevierStyleInf">2</span>&#41; prior to extubation &#40;OR 5&#46;246&#59; 95&#37; CI 2&#46;540&#8211;10&#46;835&#41;&#44; higher partial pressure of carbon dioxide &#40;PCO<span class="elsevierStyleInf">2</span>&#41; prior to extubation &#40;OR 7&#46;820&#59; 95&#37; CI 3&#46;725&#8211;16&#46;420&#41;&#44; and higher amounts of lactic acid &#40;OR 1&#46;478&#59;95&#37; CI 1&#46;063&#8211;2&#46;056&#41;&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusions</span><p id="spara012" class="elsevierStyleSimplePara elsevierViewall">Higher GA&#44; higher pre-extubation pH&#44; lower pre-extubation FiO<span class="elsevierStyleInf">2</span> and PCO&#44; and lower age at extubation are significant predictors of successful extubation among extremely and very preterm infants&#46;</p></span>"
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          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Predictors of successful extubation &#40;OR&#60;1&#41; and failed extubation &#40;OR&#62;1&#41;&#46; FiO<span class="elsevierStyleInf">2</span>&#44; fraction of inspired oxygen&#59; GA&#44; gestational age&#59; GDM&#44; gestational diabetes mellitus&#59; PCO<span class="elsevierStyleInf">2</span>&#44; partial pressure of carbon dioxide&#59; PIH&#44; pregnancy-induced hypertension&#59; SGA&#44; small for gestational age Note&#58; PCO<span class="elsevierStyleInf">2</span>&#44; FiO<span class="elsevierStyleInf">2</span> were in-transformed&#59; <span class="elsevierStyleItalic">P</span> value was calculated by generalized linear model&#46;</p>"
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          "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Cutoffs of pH &#40;left&#41; and age at extubation &#40;right&#41; for failed extubation&#44; Note&#58; p value was calculated by restricted cubic spline&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics Mean &#40;SD&#41;&#44; median &#40;IQR&#41;&#44; or n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">Infant&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">At birth</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Birth weight &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1298&#46;25 &#40;300&#46;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1075&#46;90 &#40;283&#46;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">GA &#40;week&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;49 &#40;1&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;98 &#40;1&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Male&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">155 &#40;62&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;70&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Cesarean section&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">144 &#40;74&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;25&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SGA &#40;&#60;10th percentile on Alexander growth curve&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;2&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;3&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;363&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Multiple birth&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;26&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;21&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;375&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Apgar score at 5 min&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;8&#44; 9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;7&#44; 9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Intubated in the delivery room&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;45&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;69&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">Pre-extubation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Surfactant treatment&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">235 &#40;94&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104 &#40;94&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Caffeine treatment&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;38&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;31&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;222&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">FiO<span class="elsevierStyleInf">2</span>&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;28&#44; 40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;30&#44; 59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;40 &#40;0&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;32 &#40;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">PCO<span class="elsevierStyleInf">2</span> &#40;kPa&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;90 &#40;3&#46;7&#44; 6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;30 &#40;4&#46;5&#44; 7&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Lactic acid&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;2 &#40;1&#46;4&#44; 3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;4 &#40;1&#46;5&#44; 5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;044&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Age at extubation &#40;d&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1&#44; 7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#44; 15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Mother&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Antenatal steroids treatment&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147 &#40;59&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">62 &#40;56&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;636&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">Prolonged rupture of membranes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">137 &#40;55&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;7&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">GDM&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45 &#40;20&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;22&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;620&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0101"></a><td class="td" title="\n
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                  \t\t\t\t">13&#46;195 &#40;4&#46;125-42&#46;209&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;052 &#40;1&#46;457-11&#46;263&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">Age at extubation&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "The rising preterm birth rate in China&#58; a cause for concern"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Zhang"
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                            2 => "Y&#46; Zhang"
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                    0 => array:2 [
                      "titulo" => "Preterm births in China between 2012 and 2018&#58; an observational study of more than 9 million women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Deng"
                            1 => "J&#46; Liang"
                            2 => "Y&#46; Mu"
                            3 => "Z Liu"
                            4 => "Y Wang"
                            5 => "M Li"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2214-109X(21)00298-9"
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                      "titulo" => "Clinical outcomes associated with high&#44; intermediate&#44; and low rates of failed extubation in an intensive care unit"
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                          "etal" => true
                          "autores" => array:6 [
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                            2 => "S&#46;M&#46; Burns"
                            3 => "YM Shim"
                            4 => "K Enfield"
                            5 => "C Brown"
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                      "doi" => "10.1016/j.jcrc.2015.02.005"
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                        "tituloSerie" => "J Crit Care"
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                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
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                        "paginaFinal" => "402"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                          "etal" => true
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                            3 => "BR Vohr"
                            4 => "WK Poole"
                            5 => "JE Tyson"
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Original article
Predictors of extubation outcomes among extremely and very preterm infants: a retrospective cohort study
Fang Hea, Dehua Wub, Yi Sunb, Yan Linc,
Corresponding author
ly26937@126.com

Corresponding author.
, Xiulan Wenc, Andy S.K. Chengd
a Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Neonatal Intensive Care Unit, Guangzhou, China
b Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Clinical Data Center, Guangzhou Medical University, Guangzhou, China
c Guangzhou Women and Children's Medical Center, Department of Nursing, Guangzhou Medical University, Guangzhou, China
d Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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This goal may be achieved using non-invasive respiratory support and&#44; among intubated infants&#44; by reducing the duration of mechanical ventilation by conducting successful extubation as early as possible&#46; Weaning from a ventilator in preterm neonates is a variable and inconsistent process among centers and clinicians who have limited ability to predict extubation readiness&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0006" class="elsevierStylePara elsevierViewall">Extubation failure has been independently associated with increased mortality&#44; longer hospitalization&#44; and more days of receiving oxygen and ventilatory support&#46;<a class="elsevierStyleCrossRefs" href="#bib0009"><span class="elsevierStyleSup">9&#8211;12</span></a> It is therefore critical to attempt extubation early and at a time when success is likely&#46; Identifying factors associated with successful extubation may help reduce the duration of mechanical ventilation&#44; improve outcomes&#44; and help to design future research studies in ventilated preterm infants&#46; However&#44; extubation failure will occur in some preterm infants&#44; often secondary to apnea&#44; atelectasis&#44; or intercurrent illness&#46; Very preterm infants are at higher risk of extubation failure than mature infants&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall">Existing research reports the risk factors for extubation failure among extremely premature infants as&#58; lower gestational age&#44; a lower five-minute Apgar score&#44; lower pH prior to extubation&#44; a higher peak fraction of inspired oxygen&#44; higher partial pressure of carbon dioxide &#40;PCO<span class="elsevierStyleInf">2</span>&#41;&#44; a higher fraction of inspired oxygen prior to extubation&#44; and small for gestational age status &#40;SGA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> However&#44; previous studies have not proposed cut-off values of independent risk factors for extubation failure&#44; and few studies have examined the impact of failed extubation on extremely and very preterm infants in China&#46;</p><p id="para0008" class="elsevierStylePara elsevierViewall">To address these research gaps this study aimed to explore the clinical or sociodemographic predictors for both successful and failed extubation among extremely and very preterm infants&#44; and to identify the cut-off points of significant predictors&#46; The hypotheses of this study are&#58; &#40;1&#41; What are the predicting factors of successful extubation&#63; &#40;2&#41; What are the predicting factors of failed extubation&#44; and the cut-off values of predicting factors for failed extubation&#63;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Study design</span><p id="para0009" class="elsevierStylePara elsevierViewall">This was a retrospective cohort study of extremely and very preterm infants intubated within 24&#160;h of birth from 2016 to 2020 at Guangzhou Women and Children&#39;s Medical Centre&#44; which has four Neonatal Intensive Care Units &#40;NICUs&#41;&#46; The human research ethics committee of Guangzhou Women and Children&#39;s Medical Centre approved this retrospective cohort study &#40;SFRKLTZ2020D03300&#41;&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Operational definitions</span><p id="para0010" class="elsevierStylePara elsevierViewall">The criteria for intubation&#44; extubation&#44; and reintubation were as follows&#46; Infants could be intubated if they met any of the following&#58; fraction of inspired oxygen &#40;FiO<span class="elsevierStyleInf">2</span>&#41; &#62; 0&#46;60 required to maintain oxygen saturation at or above 85&#37; using pulse oximeter&#59; PCO<span class="elsevierStyleInf">2</span> &#62; 65&#160;mm Hg&#44; pH &#60; 7&#46;2&#59; or hemodynamic instability&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> Intubation could also be performed at any time for repetitive apnea requiring positive pressure ventilation&#44; clinical shock&#44; sepsis&#44; or the need for surgery&#46; Extubation was to be attempted if the infant met all of the following criteria&#58; PCO<span class="elsevierStyleInf">2</span> &#60; 65&#160;mm Hg&#44; pH &#62; 7&#46;20&#59; oxygen saturation &#8805; 88&#37; &#40;extubation can be considered when oxygen saturation reaches 88&#37; or higher&#41;&#59; FiO<span class="elsevierStyleInf">2</span> &#8804; 0&#46;50&#59; mean airway pressure &#60; 10&#160;cm H<span class="elsevierStyleInf">2</span>O&#59; a ventilator rate of &#8804; 20 breaths per minute&#59; an amplitude of less than twice the mean airway pressure if high-frequency oscillatory ventilation was being used&#59; hemodynamic stability&#59; and the absence of clinically significant patent ductus arteriosus&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> The infants were extubated in a model of non-invasive respiratory support by continuous positive airway pressure &#40;CPAP&#41;&#44; or non-invasive positive pressure ventilation &#40;NIPPV&#41;&#46; The criteria for reintubation were the same as those for initial intubation&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Sample size calculation</span><p id="para0011" class="elsevierStylePara elsevierViewall">As this is a retrospective cohort study&#44; the authors calculated the sample size post-hoc&#46; The authors calculated the performance of each variable related to extubation failure based on the existing sample size and found that the statistical power was greater than 0&#46;8&#44; indicating the sample size of 385 to be sufficient&#46; The authors used an event per variable &#40;EPV&#41; method to estimate the sample size required for the final multivariate logistic regression &#8211; with the EPV equal to 10&#44; the final model was controlled to include eight variables at most&#46; With a missing rate of 10&#37;&#44; the number of patients with extubation failure in the study was at least 88&#46; In this study the extubation failure in the present study&#39;s sample was 110&#44; indicating that the sample size of this study is sufficient&#46;</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Study participants</span><p id="para0012" class="elsevierStylePara elsevierViewall">Infants were eligible if they had a gestational age &#40;GA&#41; of under 32 weeks&#44; had been receiving mechanical ventilation through an endotracheal tube within 24&#160;h of birth&#44; and were scheduled to undergo extubation for the first time with &#8220;non-invasive&#8221; respiratory support in one of four NICUs of a regional children&#39;s medical centre in southern China&#46; Infants were ineligible if they had a known major congenital anomaly that might affect breathing&#44; or if they were intentionally stopped active treatment at NICU by parents&#46; All subjects with pulmonary hypoplasia were excluded from this study&#46;</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Outcome measures</span><p id="para0013" class="elsevierStylePara elsevierViewall">The primary outcome was successful extubation for longer than three days&#46; Secondary outcomes were BPD&#44; death&#44; BPD&#47;death&#44; retinopathy of prematurity &#40;ROP&#41;&#44; severe ROP &#40;defined as needing surgery&#41;&#44; necrotizing enterocolitis&#44; severe necrotizing enterocolitis &#40;defined as needing surgery&#41;&#44; ligation of patent ductus arteriosus &#40;PDA&#41;&#44; intracranial hemorrhage &#40;ICH&#41;&#44; days on mechanical ventilation&#44; and increased length of hospital stay among survivors&#46; BPD was defined as the use of supplemental oxygen at 36 weeks postmenstrual age &#40;PMA&#41; or at discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Infants receiving high&#47;low flow nasal cannula of 21&#37; at 36 weeks were corrected by gestational age and labeled as BPD&#46; Successful extubation was defined as survival without the need for respiratory support with an endotracheal tube for more than three days&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> Extubation failure was defined as the need for reintubation for any reason within 72&#160;h following extubation&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Hence&#44; this study defined extubation success or failure as occurring up to three days following extubation&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> Increasingly&#44; studies define reintubation within three days after extubation as extubation failure<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> as this captures most clinical information regarding extubation failure and avoids the inclusion of new pathogenic factors in the reasons for extubation failure&#46;</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Data collection</span><p id="para0014" class="elsevierStylePara elsevierViewall">Detailed data were collected on baseline characteristics&#58; gestational age&#44; birth weight&#44; sex&#44; mode of delivery&#44; small for gestational age &#40;SGA&#41;&#44; Apgar score at five minutes after birth&#44; prolonged premature rupture of membranes &#40;&#62; 18&#160;h&#41;&#44; multiple births&#44; maternal age&#44; hypertensive disorders in pregnancy&#44; gestational diabetes mellitus&#44; maternal fever at one week before delivery&#44; antenatal steroids administration&#44; and resuscitation in the delivery room&#46; Peri-extubation characteristics were collected&#44; including surfactant treatment&#44; caffeine treatment&#44; ventilator support &#40;FiO<span class="elsevierStyleInf">2</span>&#44; pH&#44; PCO<span class="elsevierStyleInf">2</span>&#44; lactic acid prior to extubation&#41;&#44; and age at extubation&#46;</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Statistical analyses</span><p id="para0015" class="elsevierStylePara elsevierViewall">To study the incidence and predictors of successful extubation&#44; the authors grouped infants according to whether the first extubation was successful&#46; The authors compared perinatal and peri-extubation characteristics of failed and successful infant extubation&#46; Categorical characteristics were compared between the two groups using a chi-square test and continuous characteristics were analyzed using t-tests&#46; For characteristics that did not follow the normal distribution&#44; the authors used logarithmic transformation to adjust their distribution&#46; Stepwise multivariate regression was used to determine factors associated with successful extubation&#46; To avoid collinearity in the multivariate model&#44; the authors screened the independent variables in advance &#40;using stepwise regression&#41; to determine the independent risk factors of extubation failure &#40;<span class="elsevierStyleItalic">p</span> values of &#60; 0&#46;05 in bivariate tests&#41;&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">The authors also used the Restricted Cubic Spline regression to analyze the trend of independent risk factors and to explore whether there was a potential nonlinear correlation and critical point between extubation failure and the risk factors&#46; Infants in the successful and failed extubation groups were compared for neonatal morbidities&#44; as outlined above in the secondary outcomes&#46;</p></span></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Results</span><p id="para0017" class="elsevierStylePara elsevierViewall">A total of 385 extremely and very preterm infants were intubated in the first 24&#160;h after birth&#46; Among these&#44; 26 infants were excluded &#40;six infants had major congenital malformations&#44; and 20 infants were not given active treatment at NICU by their parents&#41;&#46; Thus&#44; 359 infants were included in the retrospective study&#46; Of these 359 infants&#44; there were 249 &#40;69&#46;4&#37;&#41; successful extubation cases and 110 &#40;30&#46;6&#37;&#41; failed cases&#46;</p><p id="para0018" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#44; infants in the failed extubation group had lower birth weight&#44; with a mean of 1075&#46;90 g &#40;SD&#160;&#61;&#160;283&#46;58&#41;&#59; lower gestational age&#44; with a mean of 27&#46;98 weeks &#40;SD&#160;&#61;&#160;1&#46;71&#41;&#59; and higher pre-extubation FiO<span class="elsevierStyleInf">2</span> rates of 40&#37;&#46; Infants in the failed extubation group were more likely to have been intubated in the delivery room&#59; had lower pre-extubation pH&#44; with a mean of 7&#46;32 &#40;SD&#160;&#61;&#160;0&#46;18&#41;&#59; had higher pre-extubation PCO<span class="elsevierStyleInf">2</span> &#40;with 6&#46;30&#160;kPa&#41; and higher amounts of pre-extubation lactic acid &#40;equalling 2&#46;4&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0019" class="elsevierStylePara elsevierViewall">Generalized linear regression analysis in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a> shows the following were associated with successful extubation&#58; higher birth weight&#44; higher gestational age &#40;GA&#41;&#44; a cesarean section delivery&#44; a higher five-minute Apgar score&#44; and higher pH prior to extubation&#46; Higher FiO<span class="elsevierStyleInf">2</span> and higher PCO<span class="elsevierStyleInf">2</span> prior to extubation were associated with failed extubation after the stepwise multivariate regression was conducted &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0020" class="elsevierStylePara elsevierViewall">Failed extubation was associated with older mothers&#44; infants intubated in the delivery room&#44; higher FiO<span class="elsevierStyleInf">2</span> prior to extubation&#44; higher PCO<span class="elsevierStyleInf">2</span> prior to extubation&#44; higher amounts of lactic acid&#44; and greater age at extubation &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Figure 1</a>&#41;&#46; The cut-off values of the independent risk factors were pH&#160;&#61;&#160;7&#46;38&#44; and age at extubation&#160;&#61;&#160;two days&#44; respectively&#46; If the pH was lower than 7&#46;38&#44; or the age at extubation was greater than two days&#44; the extubation failure rate was higher &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0021" class="elsevierStylePara elsevierViewall">As shown in Appendix &#40;Supplementary Material&#41;&#44; the risk of BPD in the failed extubation group was 2&#46;753 times higher than that of the successful extubation group&#46; The risk of death before discharge in the failed extubation group was 14&#46;058 times higher than that of the successful extubation group&#46; The risk of BPD&#47;death in the failed extubation group was 12&#46;304 times higher than that of the successful extubation group&#46; The risk of ROP in the failed extubation group was 1&#46;774 times higher than that of the successful extubation group&#46; The risk of severe ROP in the failed extubation group was 4&#46;037 times higher than that of the successful extubation group&#46; The risk of PDA ligation in the failed extubation group was 4&#46;349 times higher than that of the successful extubation group&#46; The adjustment factors were gestational age&#44; pre-extubation pH&#44; pre-extubation PCO<span class="elsevierStyleInf">2</span>&#44; pre-extubation FiO<span class="elsevierStyleInf">2</span>&#44; and age at extubation&#46; Of the survivors&#44; infants in the failed extubation group had longer hospital stays and spent more days on mechanical ventilation compared with those in the successful extubation group &#40;Appendix&#41;&#46;</p></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Discussion</span><p id="para0022" class="elsevierStylePara elsevierViewall">In this retrospective cohort study of extremely and very preterm infants intubated within 24&#160;h after birth&#44; extubation success was predicted by higher gestational age&#44; higher pre-extubation pH&#44; lower FiO<span class="elsevierStyleInf">2</span> prior to extubation&#44; and lower pre-extubation PCO<span class="elsevierStyleInf">2</span>&#44; and lower age at extubation&#46; Infants in the present cohort study who experienced extubation failure were more likely to experience BPD and die before discharge from the hospital&#44; as well as needing prolonged mechanical ventilation and hospitalization&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">Preterm infants may fail extubation due to the increased work of breathing&#44; significant apnea and bradycardia&#44; low oxygen saturation&#44; respiratory acidosis&#44; and upper airway narrowing&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> The predictive value for extubation success among infants with higher GAs was expected&#46; Clinicians caring for extremely preterm infants are aware of the increased risk of extubation failure in immature infants compared with more mature infants&#46; In the original randomized trial<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> the rate of re-intubation was 32&#37; in extremely preterm infants&#44; compared with 7&#37; for very preterm infants&#46; Most clinicians also consider blood gas measurements&#44; including PCO<span class="elsevierStyleInf">2</span>&#44; before extubation<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> in the knowledge that mechanically ventilated infants with severe hypercapnia are unlikely to be able to generate adequate spontaneous tidal volumes to be successfully extubated&#46;</p><p id="para0024" class="elsevierStylePara elsevierViewall">Higher pre-extubation pH&#44; lower pre-extubation FiO<span class="elsevierStyleInf">2</span>&#44; and age at extubation independently predicted extubation success in the present study&#46; Consistent with previous research&#44; a higher pre-extubation pH&#44; higher five-minute Apgar scores&#44; and higher GA were associated with extubation success&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Further consistent with previous research&#44; age at extubation was a significant predictor of successful extubation&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> This study also found that if the age at extubation was greater than two days&#44; the extubation failure rate increased accordingly&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">The authors found in the univariate analysis that cesarean section deliveries&#44; older mothers&#44; and lower lactate pre-extubation were associated with extubation failure&#44; but no association was found in the multivariate analysis&#46; These results might be caused by collinearity&#59; they were not independent risk factors&#46; Additionally&#44; the authors found there was a nonlinear relationship between extubation failure&#44; age at extubation&#44; and carbon dioxide partial pressure&#46; The present data showed that when the pre-extubation pH was lower than 7&#46;38 and the age at extubation was greater than two days&#44; the risk of extubation failure would increase significantly&#46;</p><p id="para0026" class="elsevierStylePara elsevierViewall">At present&#44; research evidence provides limited guidance on extubation indicators&#46; Previous studies evaluating whether newborns should be extubated have focused on clinical symptoms and pulmonary function indicators&#46;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> The present study indicates that pH and age at extubation may be used as significant predictors of failed extubation and suggests cut-off values to judge extubation failure&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">Extubation failure has an adverse effect on the prognosis of newborns&#46; The authors found those very preterm infants who failed extubation had higher rates of neonatal morbidities&#44; including BPD&#44; death&#44; combined outcomes of BPD&#47;death&#44; ROP&#47;severe ROP&#44; and ligation of PDA&#46; Among survivors&#44; those in the failed extubation group spent longer on mechanical ventilation and had longer hospital stays compared with those in the successful extubation group&#46; The present study&#39;s results are consistent with studies by Manley et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> and Chawla et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Both these studies were conducted among extremely preterm infants born at less than 28 weeks gestational age and found that failed extubation was associated with BPD&#44; death&#44; longer hospital stays&#44; and ventilation courses&#46; Manley et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> also noted that extremely preterm infants who failed extubation were more likely to experience severe retinopathy of prematurity and PDA ligation&#46; Chawla et&#160;al&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> noted that extremely preterm infants who failed extubation were more likely to experience severe intracranial hemorrhages &#40;grade III&#47;IV&#41; and late-onset sepsis&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">Endotracheal reintubation is not an easy process&#46; Recent studies reported successful intubation rates of between 60&#37; and 73&#37; in preterm neonates&#44; as well as long periods of time &#40;51&#160;&#177;&#160;28&#160;s&#41; needed for intubation&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> Endotracheal intubation is associated with discomfort for the infant and may result in malposition of the tube&#44; trauma to the airway&#44; and hemodynamic instability&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a> Endotracheal intubations have also been associated with alterations in brain function&#44; as monitored by electroencephalography&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> Reintubation is associated with an increase in nosocomial pneumonia and high mortality&#44; and it is critical to identify effective intervention strategies for avoiding reintubation&#46;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a></p><p id="para0029" class="elsevierStylePara elsevierViewall">There are several limitations to this study&#46; It involved a retrospective cohort study of data with selection bias&#44; as the infants included in the analysis&#44; were cared for in one center&#46; Even though the authors adjusted for important and significant clinical variables&#44; there could have been unknown differences in the failed and successful extubation groups that may be associated with both failed extubation and neonatal morbidity&#46; The authors did not analyze the impact of different ventilator modes on extubation failure as the study focused only on initial extubation failure&#46; In clinical practice&#44; infants could have repeated intubation and extubation episodes&#46; A recent systematic review noted that prophylactic methylxanthines reduce the rate of extubation failure in premature infants&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> In the present study&#39;s analysis&#44; there was no statistical difference in the use of caffeine before extubation in either the successful or failed extubation groups&#46; Whether or not the association between extubation failure and morbidities such as BPD or death were related to the extubation procedure itself could not be determined from these data&#46; The cut-off values for predicting the failure of extubation obtained in this study are for reference only and need to be further confirmed by a large sample and multi-center study&#46; The failure extubation rate of 30&#37; was higher than in other studies&#44; and this may reflect the treatment status in the present study&#39;s center&#46; Finally&#44; as this is a retrospective cohort study&#44; the authors did not collect specific modality parameters for post-extubation respiratory support&#44; and therefore this study could not examine the effect of different modalities on extubation&#46;</p></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Conclusions</span><p id="para0030" class="elsevierStylePara elsevierViewall">This study found that higher GA&#44; higher pre-extubation pH&#44; lower pre-extubation FiO<span class="elsevierStyleInf">2</span> and PCO<span class="elsevierStyleInf">2</span>&#44; and lower age at extubation are significant predictors of successful extubation among extremely and very preterm infants&#46;</p></span></span>"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Objective</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">To explore the clinical or sociodemographic predictors for both successful and failed extubation among Chinese extremely and very preterm infants</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Methods</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study was carried out among extremely and very preterm infants born at less than 32 weeks of gestational age &#40;GA&#41;&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">Compared with the infants who experienced extubation failure&#44; the successful infants had higher birth weight &#40;OR 0&#46;997&#59; CI 0&#46;996&#8211;0&#46;998&#41;&#44; higher GA &#40;OR 0&#46;582&#59; 95&#37; CI 0&#46;499&#8211;0&#46;678&#41;&#44; a caesarean section delivery &#40;OR 0&#46;598&#59; 95&#37; CI 0&#46;380&#8211;0&#46;939&#41;&#44; a higher five-minute Apgar score &#40;OR 0&#46;501&#59; 95&#37; CI 0&#46;257&#8211;0&#46;977&#41;&#44; and a higher pH prior to extubation &#40;OR 0&#46;008&#59; 95&#37; CI 0&#46;001&#8211;0&#46;058&#41;&#46; Failed extubation was associated with older mothers &#40;OR 1&#46;055&#59; 95&#37; CI 1&#46;013&#8211;1&#46;099&#41;&#44; infants intubated in the delivery room &#40;OR 2&#46;820&#59; 95&#37; CI 1&#46;742&#8211;4&#46;563&#41;&#44; a higher fraction of inspired oxygen &#40;FiO<span class="elsevierStyleInf">2</span>&#41; prior to extubation &#40;OR 5&#46;246&#59; 95&#37; CI 2&#46;540&#8211;10&#46;835&#41;&#44; higher partial pressure of carbon dioxide &#40;PCO<span class="elsevierStyleInf">2</span>&#41; prior to extubation &#40;OR 7&#46;820&#59; 95&#37; CI 3&#46;725&#8211;16&#46;420&#41;&#44; and higher amounts of lactic acid &#40;OR 1&#46;478&#59;95&#37; CI 1&#46;063&#8211;2&#46;056&#41;&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusions</span><p id="spara012" class="elsevierStyleSimplePara elsevierViewall">Higher GA&#44; higher pre-extubation pH&#44; lower pre-extubation FiO<span class="elsevierStyleInf">2</span> and PCO&#44; and lower age at extubation are significant predictors of successful extubation among extremely and very preterm infants&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abss0001"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abss0002"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abss0003"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abss0004"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="para0031a" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="ecom0001"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix"
            "titulo" => "Supplementary materials"
            "identificador" => "sec0014"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "fig0001"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2168
            "Ancho" => 2917
            "Tamanyo" => 154727
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0001"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Predictors of successful extubation &#40;OR&#60;1&#41; and failed extubation &#40;OR&#62;1&#41;&#46; FiO<span class="elsevierStyleInf">2</span>&#44; fraction of inspired oxygen&#59; GA&#44; gestational age&#59; GDM&#44; gestational diabetes mellitus&#59; PCO<span class="elsevierStyleInf">2</span>&#44; partial pressure of carbon dioxide&#59; PIH&#44; pregnancy-induced hypertension&#59; SGA&#44; small for gestational age Note&#58; PCO<span class="elsevierStyleInf">2</span>&#44; FiO<span class="elsevierStyleInf">2</span> were in-transformed&#59; <span class="elsevierStyleItalic">P</span> value was calculated by generalized linear model&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0002"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1778
            "Ancho" => 2833
            "Tamanyo" => 174342
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0002"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Cutoffs of pH &#40;left&#41; and age at extubation &#40;right&#41; for failed extubation&#44; Note&#58; p value was calculated by restricted cubic spline&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0001"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0003"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">FiO2&#44; fraction of inspired oxygen&#59; GA&#44; gestational age&#59; GDM&#44; gestational diabetes mellitus&#59; IQR&#44; interquartile range&#59; PCO2&#44; partial pressure of carbon dioxide&#59; PIH&#44; pregnancy-induced hypertension&#59; SGA&#44; small for gestational age&#46;</p><p id="spara005" class="elsevierStyleSimplePara elsevierViewall">Note&#58; Chi-squared test for categorical variables and student&#39;s <span class="elsevierStyleItalic">t</span>-test for continuous variables&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics Mean &#40;SD&#41;&#44; median &#40;IQR&#41;&#44; or n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Successful extubation &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;249&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Failed extubation &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;110&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0005"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Infant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0007"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">At birth</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Birth weight &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1298&#46;25 &#40;300&#46;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1075&#46;90 &#40;283&#46;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">GA &#40;week&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;49 &#40;1&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;98 &#40;1&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Male&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">155 &#40;62&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;70&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Cesarean section&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">144 &#40;74&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;25&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SGA &#40;&#60;10th percentile on Alexander growth curve&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;2&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;3&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;363&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Multiple birth&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;26&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;21&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;375&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Apgar score at 5 min&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;8&#44; 9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;7&#44; 9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Intubated in the delivery room&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;45&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;69&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">Pre-extubation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Surfactant treatment&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">235 &#40;94&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104 &#40;94&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Caffeine treatment&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;38&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;31&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;222&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">FiO<span class="elsevierStyleInf">2</span>&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;28&#44; 40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;30&#44; 59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;40 &#40;0&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;32 &#40;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">PCO<span class="elsevierStyleInf">2</span> &#40;kPa&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;90 &#40;3&#46;7&#44; 6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;30 &#40;4&#46;5&#44; 7&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Lactic acid&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;2 &#40;1&#46;4&#44; 3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;4 &#40;1&#46;5&#44; 5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;044&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Age at extubation &#40;d&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1&#44; 7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#44; 15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Mother&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Antenatal steroids treatment&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147 &#40;59&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;56&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;636&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Prolonged rupture of membranes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;55&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;55&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;939&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Maternal age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;51 &#40;5&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;15 &#40;5&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;399&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">PIH&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;7&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;13&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;085&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0097"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">GDM&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;20&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0099"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;22&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;620&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Maternal fever at one week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">before delivery&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;5&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;8&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Characteristics of infants in successful and failed extubation groups&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0004"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spara007" class="elsevierStyleSimplePara elsevierViewall">FiO<span class="elsevierStyleInf">2</span>&#44; fraction of inspired oxygen&#59; GA&#44; gestational age&#59; PCO<span class="elsevierStyleInf">2</span>&#44; partial pressure of carbon dioxide&#46;</p><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">Note&#58; PCO<span class="elsevierStyleInf">2</span>&#44; FiO<span class="elsevierStyleInf">2</span> were in-transformed&#59; <span class="elsevierStyleItalic">P</span> value was calculated by stepwise multivariate regression model&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0109"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0110"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0111"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">GA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;555 &#40;0&#46;435-0&#46;709&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;016 &#40;0&#46;00-0&#46;296&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;005&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 00217557
Original language: English
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