Abstract:
Background and aims: Severe brain injury (SBI) is a major morbidity among extremely preterm neonates. Endotracheal tube (ET) suctioning has been implicated in cerebral hemodynamic changes that may precede SBI detected by cranial ultrasound. It remains unclear whether frequent ET suctioning is a risk factor for SBI. Methods: This was a retrospective analysis of neonates born at <29 weeks' gestation, admitted to a level III Neonatal Intensive Care Unit (NICU), intubated within the first 72 hours of life, and remaining intubated until completion of 72 hours of life. ET suctioning events were analyzed as <9 times in 72 hours versus ≥9 times in 72 hours, allowing for 2-3 suctioning events per 24 hours among intubated neonates. Grade 1-2 intraventricular hemorrhage (IVH) was classified as mild brain injury (MBI), and Grade 3-4 IVH or periventricular leukomalacia was classified as SBI. Results: There were 146 neonates; three neonates (2%) died on days 1-3 before head ultrasound was performed and were excluded from the analysis. There was no brain injury in 67 (47%) neonates, 32 (22%) had MBI, and 44 (31%) had SBI. ET suctioning ≥9 times was a significant predictor of SBI after adjusting for antenatal steroid, magnesium sulfate, gestational age, and birth weight (p=0.048). Conclusion: ET suctioning more than the bare minimum seems to be associated with SBI in extremely premature neonates. As part of a Plan-Do-Study-Act (PDSA) cycle in our Quality Improvement initiative to reduce rates of preterm brain injury, NICU staff have been educated around limiting ET suctioning and data is forthcoming.
