Document Detail


First intention high-frequency oscillatory and conventional mechanical ventilation in premature infants without antenatal glucocorticoid prophylaxis.
MedLine Citation:
PMID:  21499177     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE:: Data comparing the effectiveness of high-frequency oscillatory ventilation and of conventional mechanical ventilation in the treatment of respiratory distress syndrome of very low birth weight infants are, to date, still matter of debate. We investigated the effects of first intention high-frequency oscillatory ventilation or conventional mechanical ventilation support on selected primary and secondary outcomes in very low birth weight infants complicated by respiratory distress syndrome in which antenatal glucocorticoid prophylaxis was not performed. DESIGN:: Multicenter randomized control trial. SETTING:: Three tertiary centers of neonatal intensive care units from December 2004 to December 2007. POPULATION:: Eighty-eight very low birth weight infants complicated by respiratory distress syndrome, without antenatal glucocorticoids, supported by first intention high-frequency oscillatory ventilation (n = 44) or conventional mechanical ventilation (n = 44). INTERVENTIONS:: All newborns were monitored by standard monitoring procedure, including routine laboratory variables, neurologic patterns, and ultrasound imaging. Primary outcomes were: the length of ventilatory support, the need of reintubation, and the length of nasal continuous positive airway pressure support in the postextubation period. Secondary outcomes were: the length of stay in neonatal intensive care unit and in hospital, death before discharge, adverse short- and long-term pulmonary and neonatal outcomes, and the need for a second dose of surfactant and of postnatal glucocorticoid treatment. RESULTS:: High-frequency oscillatory ventilation infants showed a significant lower duration (p < .001 for all) of ventilator dependency, lower need of reintubation and of duration of nasal continuous positive airway pressure support in the postextubation period. Among secondary outcomes in the high-frequency oscillatory ventilation infants, the need of a second dose of surfactant administration, and the length of stay in the neonatal intensive care unit and in hospital were significantly lower (p < .05 for all). CONCLUSIONS:: We found that high-frequency oscillatory ventilation in very low birth weight infants without antenatal glucocorticoid prophylaxis reduced the need of ventilatory support, surfactant therapy, and reintubation, and shortened neonatal intensive care unit and hospital stay, thus reducing unit and hospital costs. These data would support the usefulness of first intention high-frequency oscillatory ventilation strategy in managing in a selected population, such as very low birth weight newborns complicated by severe respiratory distress syndrome not antenatally treated with glucocorticoids.
Authors:
Vincenzo Salvo; Luc J Zimmermann; Antonio W Gavilanes; Ignazio Barberi; Alberto Ricotti; Raul Abella; Alessandro Frigiola; Alessandro Giamberti; Pasquale Florio; Paolo Tagliabue; Lucia G Tina; Francesco Nigro; Francesca Temporini; Diego Gazzolo
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-14
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  -     ISSN:  1529-7535     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Department of Maternal, Fetal and Neonatal Medicine (VS, LGT, FN), G. Garibaldi Hospital, Catania, Italy; Department of Pediatrics and Neonatology (LGZ, AWG), School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Maternal, Fetal and Neonatal Medicine (IB), University of Messina, Messina, Italy; Department of Maternal, Fetal and Neonatal Medicine (AR, FT, DG), C. Arrigo Children's Hospital, Alessandria, Italy; Department of Cardiac Surgery (RA, AF, AG), San Donato Milanese University Hospital, San Donato Milanese, Italy; Department of Pediatrics, Obstetrics and Reproductive Medicine (PF), University of Siena, Siena, Tuscany, Italy; Neonatal Intensive Care Unit (PT), San Gerardo Hospital, Monza, Italy; and Departments of Pediatrics and Neuroscience (DG), Giannina Gaslini Children's University Hospital, Genoa, Italy.
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