Complications and Consequences of the Decision to Delay Extubation Post-operatively in Surgical Neonatal Intensive Care Unit Patients

Purpose: Management of respiratory status of newborns is a point of focus for quality of care in the Neonatal Intensive Care Unit (NICU). Long periods of intubation in neonatal patients is associated with adverse events such as bronchopulmonary dysplasia (BPD), ventilation associated pneumonia, and consequent neurodevelopmental delay. This has led to a greater movement in promoting expedited extubation in the NICU. However, it is often assumed that NICU patients require prolonged intubation following a surgical intervention, and most institutions lack a clear post-operative extubation protocol for NICU patients. It is not clear what the potential consequence of this decision is with regards to respiratory morbidities, and there is a need to study the effects of delayed extubation following procedures. Methods: This study used a single-site retrospective cohort on all NICU patients who were intubated for a surgical procedure from January 2010 to December 2016. Documented data included patients' pre-operative intubation status, whether post-operative extubation occurred immediately (within 24hrs) or delayed (beyond 24hrs), whether the procedure was emergent vs. non-emergent, adverse respiratory events, and number of days in the hospital. The tabulated respiratory adverse events included: need for reintubation, unplanned self-extubation, post-operative atelectasis/pneumonia, episodes of bradycardia/apnea/desaturation, acidemia, and death. The post-operative extubation status and the presence or lack of adverse respiratory events were organized categorically and the p-value was calculated through the use of a chi-squared test. The primary outcome of the study was determination of the incidence of in-hospital adverse events in association with delayed post-operative extubation, while the secondary outcome of the study was post-operative length of stay in the hospital. Results: 99 surgical procedures were performed during this period. 33 procedures were excluded because of use of alternative methods for respiratory support such as spinal anesthesia and LMA. 8 more procedures were excluded due to intubation in the days leading up to surgery, indicating an underlying respiratory condition independent of the surgical procedure and the intubation. 58 surgical procedures were identified where the patient was intubated for the surgical intervention, of which 28 experienced immediate post-operative extubation, and 30 procedures had delayed extubation. The incidence of