Complicated Intubations Are Associated with Bronchopulmonary Dysplasia in Very Low Birth Weight Infants

Background: Neonatal intubations have been shown to have frequent complications, including severe desaturation <60%. Studies have examined strategies to reduce complications, but no studies have examined the association of complicated intubations with adverse long-term outcomes in the neonatal population. The objective was to evaluate the association between desaturation <60% (severe desaturation) during intubation and total number of intubation attempts in the first week of life in very low birth weight (VLBW) infants with adverse long-term outcomes including bronchopulmonary dysplasia (BPD) and periventricular/intraventricular hemorrhage grade 3 or 4 (severe PIVH).

Methods: A retrospective chart review was performed on infants less than 1500 grams (VLBW) who were intubated in the neonatal intensive care unit during the first week of life between January 2017 and July 2020. Descriptive tables were generated for two outcomes including BPD and PIVH. Multivariable logistic regression was then performed for each outcome including significant predictors that differed between groups with a p-value of <0.2.

Results: A total of 146 patients were included. Patients with BPD and PIVH had a lower gestational age, and patients with BPD also had a lower birth weight. Patients who developed BPD had a greater number of intubation attempts in the first week of life (4 vs. 3, P<0.001). In a multivariable logistic regression controlling for confounding variables, the odds of developing BPD were higher for patients with an increased cumulative number of intubation attempts in the first week of life (OR=1.29, CI 1.03-1.62, P=0.029). Post-hoc analyses to better determine the relationship between BPD and intubations revealed an increased number of intubation encounters in the first week of life was associated with increased odds of developing BPD (OR=2.20, CI 1.04-4.82, P=0.043). In this model, desaturation <60% in any intubation in the first week of life was also associated with increased odds of BPD (OR=2.35, CI 1.02-5.63, P=0.048). However, BPD development was not affected by the average number of intubation attempts per encounter (OR =1.06, CI 0.85-1.42, P=0.7). When including intubation encounters in the model, desaturation <60% during intubation in the first week of life was associated with increased odds of developing BPD (OR=2.35, CI 1.02-5.63, P=0.048).

Conclusion: The odds of developing BPD for VLBW infants are higher with more intubation attempts and intubation encounters during intubation in the first week of life. There is a possible association between severe desaturation and BPD, however additional studies are needed to evaluate this relationship as it was only detected in post-hoc analyses. Further research is needed to determine the mechanisms of the relationship between complicated intubations and the development of BPD.