Early Extubation failure predicts neurodevelopmental delay in infants after cardiac surgery: A retrospective cohort study

Background: Infants who undergo cardiac surgery are at increased risk of adverse neurological outcomes. Extubation failure, often seen in the immediate postoperative period, may be an early clinical sign of underlying physiologic instability. However, its long-term impact on neurodevelopment remains poorly understood. Objectives: This study aimed to determine whether early extubation failure independently predicts neurodevelopmental delay (NDD) in infants 12–24 months following cardiac surgery. Methods: We performed a retrospective cohort study involving 154 infants under 12 months of age who underwent cardiopulmonary bypass surgery between January 2016 and December 2022. Early extubation failure was defined as reintubation within 72 h after planned extubation. Neurodevelopmental outcomes were assessed using standardized developmental evaluations. Multivariate logistic regression was used to analyze the association between extubation failure and subsequent NDD. Results: Extubation failure occurred in 16.9% of infants. Among those, 42.3% demonstrated NDD, compared to 18.6% in the successful extubation group. After adjusting for potential confounders, early extubation failure remained a significant independent predictor of NDD. Additional associations included prolonged ICU stays, higher sedative exposure, and increased readmission rates. Conclusions: Early extubation failure following infant cardiac surgery is strongly associated with future neurodevelopmental impairment. This highlights the need for targeted extubation strategies, perioperative optimization, and structured developmental surveillance in this high-risk group. Extubation failure may serve as a sentinel marker for early developmental surveillance.