Neurodevelopmental Outcomes at 1 Year of Age after Extubation Failure in Very Preterm Infants: A Single-Center Cohort Study

Purpose: Early extubation from mechanical ventilation (MV) in preterm infants may reduce MV-related complications in this population. However, extubation failure (EF) remains a common clinical challenge associated with short-term morbidity and potentially adverse long-term neurodevelopmental outcomes. This study investigated the association between EF and subsequent neurodevelopment in very preterm infants using Bayley assessments performed at a corrected age of 12–18 months.Methods: This retrospective cohort study included preterm infants born at <32 weeks’ gestation between January 2017 and December 2021. Infants who required reintubation within 7 days of at least one extubation attempt were classified as having EF, whereas those who did not require further MV after extubation were classified as extubation success (ES). The infants were matched 1:1 by gestational age and birth weight. Clinical characteristics were compared between the two groups and neurodevelopmental outcomes were assessed during outpatient follow-up using the Bayley Scales of Infant and Toddler Development at a corrected age of 12–18 months.Results: The corrected age at Bayley assessment did not differ between the EF and ES groups (EF: 14.75 months [interquartile range, IQR, 12 to 19.1] vs. ES: 14.42 months [IQR, 11.7 to 21.7], P=0.95). Infants in the EF group demonstrated significantly lower composite scores across all developmental domains than those in the ES group, including cognition (93.88 vs. 94.41, P=0.021), language (89.24 vs. 89.76, P=0.030), and motor function (86.12 vs. 88.53, P=0.016).Conclusion: EF may be a clinically useful marker for identifying preterm infants at an increased risk of adverse short-term clinical courses, such as prolonged hospitalization and subsequent neurodevelopmental vulnerability. Accordingly, infants who experience EF should undergo structured, ongoing developmental surveillance, and early rehabilitative interventions should be considered when developmental delay is suspected.