High-frequency oscillatory ventilation compared with conventional intermittent mechanical ventilation in the treatment of respiratory failure in preterm infants: Neurodevelopmental status at 16 to 24 months of postterm age

doi:10.1016/S0022-3476(05)80142-8

The Journal of Pediatrics

Volume 117, Issue 6, December 1990, Pages 939-946

https://doi.org/10.1016/S0022-3476(05)80142-8 Get rights and content

The High-Frequency intervention Trial was a 10-center randomized clinical trial to test the efficacy and safety of high-frequency oscillatory ventilation (HFO) in the treatment of neonates welghing 750 to 2000 gm; 327 infants were assigned to HFO and 346 to conventional intermittent mechanical ventilation (IMV). Survival and lung morbidity rates were the same in the two groups. Bayley psychometric evaluations and CNS examination were performed at 16 to 24 months of postterm age in 77% of the survivors (185HFO and 201 IMV). There was no difference in growth or respiratory status at follow-up, Cerebral paisy was diagnosed in 19 (10%) HFO-treated infants and 23 (11%) IMV-treated infants. There was no difference in severity between the two groups. A signifiantly higher incidence of hydrocephalus (12% vs 6%) was present in the HFO group (p<0.05). Bayley index scores>83 were scored in 57% of HFO-treated infants compared with 66% of IMV-treated infants. The proportion of children atfollow-up with a normal neuro-developmental status (i.e., Bayley score>83 and no major CNS defect) was significantly less in the HFO than in the IMV group (54 vs 65%; p<0.05). Both treatment groups showed a strong association between the presence of grade 3 or 4 intraventricular hemorrhage and the development of major CNS or cognitive defects. No significant long-term beneficial or deleterious effects were demonstrated in the use of HFO versus IMV for the treatment of respiratory failure in low birth weight premature infants, except that there were slightly more neurologic deficits in the HFO group related to the higher proportion of survivors with major intraventricular hemorrhage.

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Most of the studies reported similar short and long-term neurodevelopmental outcome of HFOV as compared to CMV. However, few trials showed an increase in severe intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) in the HFOV groups [42,43] while some others showed a reduction in the risk of cerebral palsy [44]. It is also hard to compare the effects of HFOV with CMV on short and long-term pulmonary and neurodevelopmental outcomes when the open lung strategy is utilized.
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^*: Supported by contracts (Nos. NO1HR46001 and NO1HR46003-46012) from the Division of Lung Diseases, National Heart, Lung, and Blood Institute Bethesda, Md.

^***: Members of the HIFI Study Group are as follows: University of California (San Diego): F. Mannino, G. Heldt, Y. Vaucher; Case Western Reserve (Cleveland, Ohio): R. Martin, W. Carlo, M. Hack; University of Manitoba, (Winnipeg): H. Rigatto, M. Davi, O. Casiro; University of Miami (Miami, Fla.): R. Goldberg, E. Bancalari, C. Bauer: University of Pennsylvania (Philadelphia): W. Fox, A. Spitzer, S, Abbasi, J. Bernbaum, J. Gerdes: University of Toronto (Toronto, Ontario): P. Fitzhardinge, P. Swyer, H. Whyte; Tufts University School of Medicine (Boston, Mass.): I. D. Frantz, B. Boynton, R. Delollis; Vanderbilt University (Nashville, Tenn.): R. Cotton, T. Hazinski; University of Washington (Seattle): W. A. Hodson, W. Truog, F. C. Bennett; University of Wisconsin (Madison): G. Gutcher, R. Perelman; Research Triangle Institute (Research Triangle Park, N. C.): W. K. Poole, A. V. Rao, M. Jordan; Division of Lung Diseases (Bethesda, Md.): E. Sinnett.

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High-frequency oscillatory ventilation compared with conventional intermittent mechanical ventilation in the treatment of respiratory failure in preterm infants: Neurodevelopmental status at 16 to 24 months of postterm age*

Clin Perinatol

J Pediatr

J Pediatr

High-frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants

N Engl J Med

Long-term follow-up of ventilator treated low birth weight infants. I. Chest x-ray, pulmonary mechanics, clinical lung disease and growth

Acta Paediatr Scand

Long-term follow-up of ventilator treated low birthweight infants. II. Neurological and psychological outcome at 6–7 years

Acta Paediatr Scand

Early development of infants of birth weight less than 1,000 grams with reference to mechanical ventilation in newborn period

Pediatrics

Infants weighing 1,000 grams or less at birth: developmental outcome for ventilated and nonventilated infants

Pediatrics

Prolonged mechanical ventilation and intracranial hemorrhage: impact on developmental progress through 18 months in infants weighing 1,200 grams or less at birth

Pediatrics

Neonatal high frequency jet ventilation: four years' experience

Pediatrics