Comparing neonatal outcomes of positive- versus negative-pressure extubation: A randomized trial

Background Neonatal respiratory distress is a major issue for many infants. When non-invasive ventilation fails, endotracheal intubation is often used to secure the airway. However, extubation moving from mechanical ventilation to spontaneous breathing also has its challenges and risks. Objective This randomized controlled trial aimed to compare neonatal outcomes between positive- and negative-pressure extubation methods in a cohort of neonates ready for extubation. Methods This randomized controlled trial was conducted at Ayatollah Taleghani Hospital in Ilam, Iran, from May 2021 to March 2023; the study enrolled 101 neonates, who were divided into three groups: positive pressure, negative pressure, and self-extubation. Neonates with congenital respiratory defects, meconium aspiration, and bacterial pneumonia were excluded from the study. The primary outcomes assessed included the duration of intubation, need for oxygen post-extubation, and length of hospitalization. Statistical analysis was performed using the independent-samples Kruskal-Wallis test, with a significance level set at p < 0.05. Results No statistically significant differences were found in the duration of intubation (p = 0.436), need for oxygen after extubation (p = 0.785), and length of hospitalization (p = 0.357) among the groups. There was a significant difference in the duration of intubation, need for oxygen after extubation, and length of hospital stay based on gestational age at birth (p = 0.000). However, there was no significant correlation between age at birth and re-intubation (p = 0.297). Conclusion There are no significant differences in key outcomes like intubation duration, post-extubation oxygen needs, and hospitalization length, suggesting that the choice of extubation method may not greatly affect these factors.