3-minute vs 10-minute Spontaneous Breathing Evaluations (SBE) for predicting extubation success in preterm very low birth weight infants: Retrospective observational study

Background Extubation in preterm very low birthweight (VLBW) infants is a critical step in respiratory management. Accurately predicting extubation success is challenging because of immature respiratory control, surfactant deficiency, and limited pulmonary reserve. The Spontaneous Breathing Evaluation (SBE) has emerged as an important bedside method to assess readiness for successful extubation, although the optimal duration of this evaluation remains uncertain. Methods This retrospective observational study included preterm neonates between 26 and 34 weeks of gestation with birthweight 10 s), bradycardia (heart rate 0.1 above baseline. Extubation decisions were based on SBE performance combined with clinical readiness criteria, including stable ventilator settings, acceptable blood gas parameters, and clinician judgment. Results Eighty-eight infants met inclusion criteria (44 in each SBE-duration group). The mean gestational age was 29.9 ± 2.1 weeks and mean birthweight was 1168 ± 258 g. The Respiratory Severity Score (RSS; calculated as FiO 2 × mean airway pressure) was significantly higher in the 10-min SBE group (1.85 ± 0.44 vs 1.67 ± 0.31; p = 0.031), indicating greater baseline respiratory severity in that group. Overall, 84% of infants tolerated the SBE and 77% achieved extubation success, while extubation failure occurred in 23%. Most SBE failures occurred within the first 3 min, regardless of total SBE duration. On univariate analysis, birthweight 2.1 strongly predicted reintubation. Multivariable logistic regression confirmed that gestational age 2.1 (OR 0.09, 95% CI 0.02–0.44; p = 0.003) were independent predictors of extubation failure, while SBE duration was not independently associated with extubation outcome ( p = 0.412). Conclusion In this hypothesis-generating retrospective study, a 3-min SBE demonstrated comparable performance to a 10-min SBE in predicting extubation success among preterm VLBW infants. Gestational maturity and RSS were stronger independent predictors of outcome. These findings require confirmation in larger prospective studies before definitive clinical recommendations can be made.