Early use of high frequency ventilation in the premature neonate.

UNLABELLED: This study evaluated whether the early use of high frequency ventilation (HFV) decreased the incidence of oxygen dependency at 36 weeks postconceptual age [chronic lung disease (CLD)] and improved developmental outcome. Neonates of less than 32 weeks gestational age needing ventilatory support for RDS who were admitted to a tertiary academic neonatal intensive care unit (NICU) within 6 h of birth were included in a prospective controlled clinical trial. With randomisation they were given either HFV (n=147) or conventional ventilation (CV) (n=153). As a primary outcome variable, ventilator and/or oxygen dependence at a postconceptual age of 36 weeks (CLD) was measured. Secondary outcome variables were: mortality at discharge, treatment failure, ventilator and/or oxygen dependence at 28-30 days (bronchopulmonary disease [BPD]), duration of ventilation, use of surfactant, days in oxygen and on continuous positive airway pressure (CPAP), survival without BPD or CLD, air leak, intracranial haemorrhages (ICH) grades 3 and 4, periventricular leukomalacia (PVL) grades 1 and 2, retinopathy of prematurity (ROP), patent ductus arteriosus (PDA), necrotising enterocolitis (NEC), developmental outcome at 7 to 12 months and if necessary at 18-24 months corrected age. The results showed that CLD (16.3 vs. 12.4%), BPD (33.3 vs. 36.6%), early cerebral abnormalities, mortality at discharge (17.2 vs. 13.2%), failure rate (11.6 vs. 6.5%) and motor and mental developmental outcome at a corrected age of 18 to 24 months (p>0.05) did not differ between the two groups.

CONCLUSION

Under the present study design HFV compared with CV did not decrease chronic lung disease and no developmental outcome differences could be found at a corrected age of almost 2 years.