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Prolonged ventilation and intact survival in very low birth weight infants
Mark Thomas1, Anne Greenough, Margaret Morton
1Department of Child Health, King's College Hospital, London SE5 9RS, United Kingdom.
Insights
Prolonged ventilation in infants can lead to poor outcomes. Discontinuous intermittent positive pressure ventilation (IPPV) showed better results than continuous IPPV, especially when combined with normal ultrasound scans.
Area of Science:
- Neonatal care
- Pediatric neurology
Background:
- Prolonged ventilation (>28 days) is linked to adverse outcomes in infants.
- Modern neonatal care includes antenatal steroids and postnatal surfactant, potentially altering outcomes.
Purpose of the Study:
- To compare outcomes of discontinuous versus continuous intermittent positive pressure ventilation (IPPV) in infants requiring prolonged ventilation.
- To determine if abnormal ultrasound findings predict poor outcomes in these infants.
Main Methods:
- Identified very low birth weight (VLBW) infants requiring prolonged ventilation (≥28 days).
- Assessed neurodevelopmental status at 1 year, defining abnormal outcome by Griffiths quotient or disability.
- Compared outcomes between continuous and discontinuous IPPV groups and correlated with cranial ultrasound findings.
Main Results:
- Of 417 VLBW infants, 41 required prolonged ventilation (30 continuous, 11 discontinuous).
- Infants receiving continuous IPPV had significantly higher rates of death or abnormal neurodevelopmental outcome (18/30) compared to discontinuous IPPV (1/11).
- All infants (8/8) with major cranial ultrasound abnormalities experienced death or abnormal outcomes.
Conclusions:
- Discontinuous IPPV is associated with better outcomes than continuous IPPV in VLBW infants.
- Abnormal cranial ultrasound findings are strong predictors of poor neurodevelopmental outcomes in infants requiring prolonged ventilation.
- While prolonged ventilation can allow intact survival, significant brain injury indicated by ultrasound predicts poor outcomes.
Unlabelled:
A requirement for prolonged ventilation (>28 days) has been associated with a poor outcome in infants. We postulated that in the present population of infants who usually receive antenatal steroids and post-natal surfactant, prolonged ventilation in discrete episodes, i.e. discontinuous intermittent positive pressure ventilation (IPPV), would have a better outcome than a requirement for prolonged ventilation continuously from birth (continuous IPPV) and, in addition, that an abnormal ultrasound scan appearance would be a reliable predictor of poor outcome in infants requiring prolonged ventilation. All very low birth weight (VLBW) infants ventilated for at least 28 days (prolonged ventilation) were identified from a prospectively maintained database. At 1 year of age, neurodevelopmental status was assessed and abnormal neurodevelopmental outcome diagnosed if the infant's Griffiths developmental quotient was at least two standard deviations below the mean and/or they had impairment with disability. Of 417 VLBW infants, 41 required prolonged ventilation (30 continuous and 11 discontinuous). In the continuous IPPV group, 18 and one in the discontinuous IPPV group died or had abnormal neurodevelopmental outcome ( P<0.01). All eight infants with major cranial ultrasound abnormalities died or had abnormal outcome ( P<0.01).
Conclusion:
prolonged ventilation can be associated with intact survival, but not in very low birth weight infants with evidence of significant brain injury.