Risk factors analysis for extubation failure following mandibular distraction osteogenesis in infants with Pierre Robin sequence: a retrospective cohort study.

BACKGROUND

Mandibular distraction osteogenesis is an important therapeutic approach for infants with Pierre Robin sequence (PRS). There is a lack of data describing risk factors for postoperative extubation failure (EF) in these infants. We aimed to identify risk factors for EF in infants with PRS and to explore the association between EF and clinical outcomes.

METHODS

A retrospective cohort study was carried out on infants with PRS who received mandibular distraction osteogenesis at our facility from January 2020 to December 2023. Extubation failure was defined as the need for non-invasive ventilation or reintubation within 24 h of extubation. Multivariate logistic regression analysis was performed to explore the risk factors for EF. Univariable statistical analysis was performed to determine associations between EF and clinical outcomes.

RESULTS

Of 135 included infants, 27 (20.0%) experienced EF. In the logistic regression analysis, postoperative pneumonia was independently associated with EF (p = 0.029). Compared to those without pneumonia, patients with postoperative pneumonia had a odds ratio (OR) of 5.25 for EF (95% CI, 1.18-23.28; p < 0.05). Mandibular distraction length, laryngeal edema, and inflammatory markers (WBC, CRP, temperature) were not associated with EF. Infants who failed extubation had longer durations of mechanical ventilation [5 days (IQR 4-7) vs. 4 days (IQR 4-5), p < 0.001], longer PICU lengths of stay [9 days (IQR 8-13) vs. 6 days (IQR 5-6), p < 0.001], and longer hospital lengths of stay [18 days (IQR 14-22) vs. 15 days (IQR 13-17), p = 0.001] than successfully extubated infants.

CONCLUSIONS

Postoperative pneumonia is associated with an increased risk of failing extubation in infants with PRS. Prospective studies are needed to evaluate whether screening for postoperative pneumonia and evaluating airway resistance before extubation can reduce the risk of EF.