Use of Prophylactic Methylxanthines to Prevent Extubation Failure in Preterm Neonates with a Birth Weight of 1250–2499 g: A Propensity Score-Matched Analysis

<b>Background/Objectives:</b> Preterm neonates with a birth weight (BW) of 500-1250 g who receive prophylactic methylxanthine have a lower rate of bronchopulmonary dysplasia and neurodevelopmental disability than their counterparts. In a meta-analysis of previous studies (published during 1985-1993, with no routine continuous positive airway pressure), extubation failure rates in preterm neonates with BW < 2500 g who received and did not receive methylxanthine were 25.0% and 50.6%, respectively (risk difference, -0.27; 95% confidence interval [CI], -0.39 to -0.15). However, no study to date has assessed the effects of prophylactic methylxanthine use on endotracheal extubation in infants weighing 1250-2499 g until now. <b>Methods</b>: First-time extubation was compared between 1:1 propensity score-matched methylxanthine and non-methylxanthine groups from a retrospective cohort of 541 neonates (born during 2014-2024). <b>Results</b>: The domains from the overall cohort and propensity-matched data included 541 and 192 neonates, respectively. In the propensity score-matched sample, the mean gestational age and BW were 30.9 ± 1.9 weeks and 1584 ± 273 g, respectively. The median 5-min Apgar score was 9 (range of 7-9). Extubation failure within 7 days occurred in 10 (10.4%) and 13 (13.5%) neonates in the methylxanthine (<i>n</i> = 96) and non-methylxanthine (<i>n</i> = 96) groups, respectively, with a risk difference (95% CI) of -0.03 (-0.12 to 0.06), <i>p</i> = 0.50, and hazard ratio (95% CI) of 0.76 (0.33 to 1.72), <i>p</i> = 0.51. <b>Conclusions</b>: In the current era with new non-invasive ventilation approaches, extubation failure in preterm neonates with a BW of 1250-2499 g is not significantly affected by the use of methylxanthine.