Prognosis of very preterm infants with severe respiratory distress syndrome receiving mechanical ventilation.

OBJECTIVE: To evaluate the prognosis of very preterm infants with severe respiratory distress syndrome (RDS) receiving mechanical ventilation. METHODS: A total of 288 preterm infants mechanically ventilated for severe RDS and completed follow-up till 18 months of corrected age comprised these study subjects. The associations of prenatal and postnatal factors, mode and duration of conventional mechanical ventilation (CMV), medication and treatment, and complications with cerebral palsy or mental developmental index (MDI) < 70 at 18 months of age were analyzed. RESULTS: The incidences of CP among study subjects were 17, 5, and 2% in infants less than 28, 28-30, and 30-32 weeks, respectively. The incidences of MDI < 70 were 49, 24, and 13% in infants less than 28 weeks, 28-30 weeks, and 30-32 weeks, respectively. Antenatal corticosteroids, preeclampsia, fetal distress, early and late bacteremia, and decreased weight gain were associated with CP and an MDI < 70. In the CP and MDI < 70 groups, the number of infants on CMV was significantly higher than on high-frequency oscillatory ventilation (HFOV). Longer duration of mechanical ventilation and blood transfusions were associated with an increased risk of having an MDI < 70 or CP. The complications in study subjects associated with an MDI < 70 or CP were BPD, NEC, and IVH grade III-IV. CONCLUSION: The prognosis of very preterm infants with severe RDS may be influenced by several prenatal and postnatal factors. HFOV although decreased the duration of mechanical ventilation, whether it will decrease the incidence of neurodevelopmental disability, needs to be explored further.

High-frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation plus pressure support in preterm infants with severe respiratory distress syndrome.

BACKGROUND: Mechanical ventilation and surfactants are the standard treatment of preterm respiratory distress syndrome (RDS). The effects of the primary ventilation model on bronchopulmonary dysplasia (BPD) and long-term neurodevelopment outcomes are controversial. The purpose of this study was to compare the efficacy and safety of high-frequency oscillatory ventilation (HFOV) and synchronized intermittent mandatory ventilation plus pressure support ventilation (SIMV-PSV) in preterm infants with severe RDS. METHODS: A total of 366 eligible preterm infants were randomly assigned to treatment with HFOV (n = 184) or SIMV-PSV (n = 182). Surfactant was applied if PaO2/FIO2 was < 200 mm Hg after 2 hours of ventilation. Primary outcomes were mortality or incidence of BPD. Secondary outcomes were duration of ventilation and hospitalization, surfactant requirements, pneumothorax, retinopathy of prematurity ≥ stage 2, and neurodevelopment at 18 months of corrected age. RESULTS: Survival and complete outcome data were available for 288 infants at 18 months of corrected age. The incidence of death or BPD was significantly higher in the SIMV-PSV group (P = .001). The duration of mechanical ventilation and hospitalization was shorter and the incidence of surfactant requirement and retinopathy of prematurity was lower in the HFOV group (P < .001, P = .002, P = .04, respectively). Moderate or severe neurological disability was less frequent in the HFOV group than in the SIMV-PSV group at 18 months (P = .03). The combination of HFOV and surfactant dramatically reduced negative outcomes in preterm infants with severe RDS. CONCLUSIONS: Initial ventilation with HFOV in preterm infants with severe RDS reduces the incidence of death and BPD, and improves long-term neurodevelopment outcomes. (ClinicalTrials.gov NCT01496508).

The use of the WINROP screening algorithm for the prediction of retinopathy of prematurity in a Chinese population.

BACKGROUND: Retinopathy of prematurity (ROP) is a gestational age (GA)-related illness that can lead to blindness in premature infants. Timely screening of premature infants could improve visual prognosis. OBJECTIVE: To evaluate the WINROP algorithm as a method of predicting severe ROP in a Chinese population. METHODS: 590 infants with a GA <32 weeks were entered into an online surveillance system (www.winrop.com) that included ROP evaluations and weekly weight measurements from birth to a corrected GA of 40 weeks. If the rate of weight gain decreased to a certain degree, the algorithm signaled an alarm that the infant was at risk for developing sight-threatening ROP. Each infant was categorized as having no, mild, or severe ROP. RESULTS: Among the 590 infants with a GA <32 weeks, an alarm was triggered in 85 infants (14.4%), 50 of which developed severe ROP and were identified in this alarm group. Twenty-seven infants triggered the alarm signal in the first week after birth and 7 infants triggered the alarm at birth. Seven of the infants developed proliferative ROP and the median GA at birth for these infants was 31 weeks. CONCLUSIONS: The WINROP system had a sensitivity of 87.5% in a Chinese population for the early identification of infants that developed severe ROP. Postnatal weight gain may help predict ROP in lower birth weight infants.