Outcome of infants with birth weights less than 1000 g with respiratory distress syndrome treated with high-frequency ventilation and surfactant replacement therapy
C. A. Patel and J. M. Klein
Department of Pediatrics, University of Iowa, Iowa City.
OBJECTIVE: To compare outcomes in premature infants with respiratory
distress syndrome who received surfactant replacement therapy and were
treated with either high-frequency or conventional mechanical ventilation.
DESIGN: Retrospective chart review of patient series. SETTING: Tertiary
academic medical center. PATIENTS: One hundred fourteen extremely
low-birth-weight infants (< 1000 g) with respiratory distress syndrome
treated with surfactant replacement therapy, consecutively admitted to the
neonatal intensive care unit between September 1989 and August 1992.
INTERVENTIONS: Treatment with either high-frequency ventilation (n = 46) or
conventional mechanical ventilation (n = 68) after surfactant replacement
therapy. MAIN OUTCOME MEASURES: Intraventricular hemorrhage and
neurodevelopmental status. RESULTS: Infants who received high-frequency
ventilation had significantly lower birth weights and were more premature
than infants receiving conventional mechanical ventilation. Despite this,
patients ventilated with high frequency had similar incidences of
intraventricular hemorrhage and impaired neurodevelopmental outcomes when
compared with the conventionally ventilated patients. As expected, the
smaller and more premature infants receiving high-frequency ventilation
required a longer duration of respiratory support (mechanical ventilation
and nasopharyngeal continuous positive airway pressure). Additionally,
multiple logistic regression analysis to control for differences in birth
weight and gestational age between the two groups revealed a significant
association between the combined use of high-frequency ventilation and
antenatal corticosteroids and the absence of either intraventricular
hemorrhage or pneumothorax. CONCLUSION: We conclude that high-frequency
ventilation combined with surfactant therapy is as safe as conventional
mechanical ventilation combined with surfactant therapy for treating
respiratory distress syndrome in extremely low-birth-weight infants (<
1000 g) and does not increase the risk of either intraventricular
hemorrhage or abnormal neurodevelopmental outcome.
