High-frequency ventilation in the management of very-low-birth-weight infants with pulmonary hemorrhage.

Severe hypoxic respiratory failure secondary to massive pulmonary hemorrhage (MPH) in preterm infants could be fatal. The aim of this study was to assess the efficacy of high-frequency ventilation (HFV) as a rescue therapy for respiratory failure secondary to MPH in very-low-birth-weight (VLBW) infants. Prospectively we followed up all VLBW infants with pulmonary hemorrhage between January 1993 and December 1996 in our neonatal intensive care unit at King Khalid University Hospital. Seventeen VLBW infants with severe hypoxic respiratory failure secondary to MPH were treated with HFV. Ten (59%) infants responded to HFV and survived, while the other 7 (41%) did not respond and expired. Patent ductus arteriosus was considered the most common associated condition in 10 infants (59%). There were no statistically significant differences between the responders and the nonresponders in regard to gestational age, birth weight, sex ratio, % inborn, and primary diagnosis. However, preintervention peak inspiratory pressure (pip), arterial-alveolar ratio (a/A ratio) and oxygenation index (OI) were higher in the nonresponders ( p = 0.02, p = 0.03, and p = 0.003, respectively), while pip, F IO(2), pa CO(2), a/A ratio and OI were significantly lower than the nonresponders 3 hours postintervention ( p = 0.008, p = 0.006, p = 0.0002, p = 0.0005, and p = 0.0007, respectively). In conclusion, HFV might be an effective and lifesaving mode of treatment in VLBW infants with respiratory failure secondary to MPH; therefore, prospective randomized controlled trials are needed to confirm these findings.