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Rescue high frequency oscillation and predictors of adverse neurodevelopmental outcome in preterm infants
Gabriel Dimitriou1, Anne Greenough, Dylan Broomfield
1Department of Child Health, King's College Hospital, 4th Floor, Ruskin Wing, SE5 9RS, London, UK.
Insights
High frequency oscillation (HFO) rescue support for premature infants may lead to abnormal neurodevelopmental outcomes. Gestational age and HFO use are significant risk factors for adverse outcomes at two years.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Respiratory Support
Background:
- High frequency oscillation (HFO) is a common rescue therapy for neonatal respiratory failure.
- A significant proportion of survivors receiving HFO exhibit abnormal neurodevelopmental findings.
- The long-term neurodevelopmental impact of HFO in extremely preterm infants requires further investigation.
Purpose of the Study:
- To identify risk factors for adverse neurodevelopmental outcomes in very prematurely born infants requiring HFO.
- To compare neurodevelopmental status at 1 and 2 years between infants receiving HFO and those on conventional mechanical ventilation (CMV).
Main Methods:
- A case-control study involving 56 infants with a median gestational age of 28 weeks.
- Infants were supported by either HFO or CMV (controls), matched for gestational age.
- Neurodevelopmental status was assessed at 1 and 2 years, with abnormal outcome defined by specific criteria.
Main Results:
- A higher proportion of HFO infants experienced abnormal neurodevelopmental outcomes at 2 years compared to controls.
- Poorer pre-transfer oxygenation was associated with abnormal outcomes in HFO infants.
- Logistic regression identified HFO use and gestational age as significant risk factors for adverse outcomes.
Conclusions:
- Initial response to HFO does not predict normal neurodevelopmental outcomes.
- Rescue HFO in very immature infants should be approached with caution due to potential neurodevelopmental risks.
Background:
High frequency oscillation (HFO) is now frequently used as rescue support, but it has been suggested that as many as one-third of survivors have abnormal neurodevelopmental findings at follow-up.
Objective:
To identify risk factors for adverse neurodevelopmental outcome at 1 and 2 years in very prematurely born patients, who, because of severe neonatal respiratory failure, had required transfer to high frequency oscillation (HFO).
Methods:
A case control study was performed. Controls were supported by conventional mechanical ventilation (CMV) only and matched to HFO infants for gestational age. At 1 and 2 years, neurodevelopmental status was assessed in both groups. Abnormal neurodevelopmental outcome was diagnosed if infants had impairment with or without disability or a Griffiths developmental quotient of at least two standard deviations below the mean.
Patients:
Fifty-six infants were studied, median gestation age of 28 weeks (range 23--31).
Results:
At 2 years of age, a greater proportion of the HFO infants compared to the controls had an abnormal outcome (p<0.05). HFO infants with an abnormal outcome compared to those with a normal outcome had poorer oxygenation prior to transfer to HFO (p=0.05), but did not have a lower initial improvement in oxygenation or longer duration of hypocarbia on HFO. Logistic regression demonstrated adverse outcomes significantly related to HFO use and gestational age in the whole study population and to gestational age in the HFO infants.
Conclusion:
An initial response to HFO does not guarantee normal neurodevelopmental outcome. Rescue HFO in very immature infants should be used cautiously.