Endotracheal tube exchange in preterm infants with evolving chronic lung disease: safety, outcomes, and impacts on pulmonary mechanics

J Perinatol. 2026 Jan;46(1):38-42. doi: 10.1038/s41372-025-02411-0. Epub 2025 Oct 15.

Abstract

Objective: A study of the safety of endotracheal tube exchange and its impact on pulmonary mechanics in preterm infants with chronic lung disease.

Study design: This retrospective cohort study included 67 infants born at less than 29 weeks gestational age who underwent endotracheal (ETT) exchange after 28 days of life in a Level 4 NICU between 2017 and 2023. Descriptive analysis was performed using the Wilcoxon rank-sum test and Chi-squared or Fisher's exact tests to characterize the cohort and compare variables before and after the ETT exchange.

Results: ETT exchange led to increased stability in 60% of cases, while adverse events occurred in 57% of exchanges. By 36 weeks postmenstrual age, 92% of the cohort developed type 2 or 3 bronchopulmonary dysplasia (BPD).

Conclusion: The majority of ETT exchanges resulted in increased stability; however, the adverse event rate was high. Further studies are needed to determine whether ETT exchange improves long-term outcomes.

MeSH terms

  • Bronchopulmonary Dysplasia* / etiology
  • Chronic Disease
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Intensive Care Units, Neonatal
  • Intubation, Intratracheal* / adverse effects
  • Intubation, Intratracheal* / instrumentation
  • Intubation, Intratracheal* / methods
  • Lung Diseases* / therapy
  • Male
  • Respiration, Artificial
  • Respiratory Mechanics
  • Retrospective Studies