Radiological outcome of very prematurely born infants randomised to high frequency oscillatory or conventional...

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Radiology

Background:

• Chest radiographs (CXRs) at 28 days or 36 weeks post-menstrual age (PMA) predict respiratory outcomes in infants.
• Understanding the impact of different ventilatory strategies on lung development is crucial for very preterm infants.

Purpose of the Study:

• To investigate if chest radiograph (CXR) findings at 28 days and 36 weeks post-menstrual age (PMA) differ between infants receiving high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV).

Main Methods:

• A multicentre randomised trial (UKOS) compared HFOV and CMV initiated within 60 minutes of birth.
• Chest radiographs (CXRs) were obtained at 28 days and 36 weeks PMA from 487 very preterm infants (median gestational age 26+5 weeks).
• CXRs were evaluated using a scoring system for fibrosis, cystic changes, and hyperinflation.

Main Results:

• No significant differences were observed in total CXR scores between the HFOV and CMV groups at 28 days (mean scores 3.2 vs 3.5) or 36 weeks PMA (mean scores 3.5 vs 3.6).
• The 95% confidence intervals for the differences in scores encompassed zero, indicating no statistically significant divergence in lung appearances between ventilation modes.

Conclusions:

• High frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) appear to have similar impacts on pulmonary function and lung structure in very prematurely born infants.
• These findings suggest that the choice of ventilation mode in the perinatal period may not lead to distinct radiographic differences by 36 weeks PMA.