Early extubation is not associated with severe intraventricular hemorrhage in preterm infants born before 29 weeks of gestation. Results of an EPIPAGE-2 cohort study

PLoS One. 2019 Apr 4;14(4):e0214232. doi: 10.1371/journal.pone.0214232. eCollection 2019.


Objective: To determine whether there is an association between severe intraventricular hemorrhage and early extubation in preterm infants born before 29 weeks of gestational age and intubated at birth.

Methods: This study included 1587 preterm infants from a nationwide French population cohort (EPIPAGE-2). Secondary data on intubated preterm infants were analyzed. After gestational age and propensity score matching (1:1) we built two comparable groups: an early extubation group and a delayed extubation group. Each neonate in one group was paired with a neonate in the other group having the same propensity score and gestational age. Early extubation was defined as extubation within 48 hours of life. Severe intraventricular hemorrhages were defined as grade III or IV hemorrhages according to the Papile classification.

Results: After matching, there were 398 neonates in each group. Using a generalized estimating equation model, we found that intraventricular hemorrhage was not associated with early extubation (adjusted OR 0.9, 95%CI 0.6-1.4). This result was supported by sensitivity analyses.

Conclusion: The practice of early extubation was not associated with an increased proportion of intraventricular hemorrhages. To complete these results, the long-term neurologic outcomes of these infants need to be assessed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Airway Extubation / adverse effects*
  • Cerebral Hemorrhage / etiology*
  • Cohort Studies
  • Female
  • Humans
  • Infant, Premature / physiology*
  • Pregnancy
  • Premature Birth / pathology*
  • Propensity Score
  • Risk Factors

Grants and funding

This project has been funded with support from the following organizations: The French Institute of Public Health Research/Institute of Public Health and its partners: the French Health Ministry, the National Institute of Health and Medical Research (INSERM), the National Institute of Cancer, and the National Solidarity Fund for Autonomy (CNSA); The National Research Agency through the French EQUIPEX program of investments in the future (reference ANR-11-EQPX-0038); the PREMUP Foundation. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.