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Ventilation in Extremely Preterm Infants and Respiratory Function at 8 Years.

Lex W Doyle1, Elizabeth Carse1, Anne-Marie Adams1

  • 1From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia.

The New England Journal of Medicine
|July 27, 2017
PubMed
Summary

Less invasive ventilation for extremely preterm infants did not improve long-term lung function or reduce oxygen dependence. Despite advances in respiratory support, infant lung health outcomes at 8 years old showed no significant improvement over time.

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Area of Science:

  • Neonatology
  • Pediatric Pulmonology
  • Respiratory Medicine

Background:

  • Less invasive ventilation strategies are increasingly used for extremely preterm infants (<28 weeks gestation).
  • The impact of these evolving respiratory support methods on short-term and long-term infant lung function remains unclear.
  • This study investigates trends in ventilation and oxygen use and their association with lung function outcomes in extremely preterm survivors.

Purpose of the Study:

  • To compare changes in assisted ventilation and oxygen therapy use during the newborn period.
  • To assess long-term lung function at 8 years of age in children born extremely prematurely.
  • To determine if less invasive ventilation strategies correlate with improved respiratory outcomes over time.

Main Methods:

  • Longitudinal follow-up of extremely preterm infants born in Victoria, Australia, across three birth cohorts (1991-1992, 1997, 2005).
  • Prospective collection of perinatal data including duration/type of ventilation, oxygen therapy duration, and oxygen requirements at 36 weeks corrected age.
  • Measurement of expiratory airflow at 8 years of age, with z-score normalization for age, height, sex, and ethnicity.

Main Results:

  • The duration of assisted ventilation, particularly nasal continuous positive airway pressure, significantly increased over time.
  • Despite increased use of less invasive ventilation, oxygen therapy duration and 36-week oxygen dependence rates increased.
  • Expiratory airflow measures at 8 years of age were significantly worse in the 2005 cohort compared to earlier cohorts.

Conclusions:

  • Increased use of less invasive ventilation in extremely preterm infants has not led to reduced oxygen dependence at 36 weeks corrected age.
  • No significant improvement in childhood lung function was observed over time despite advancements in respiratory support.
  • These findings highlight a need to re-evaluate current ventilation and oxygen strategies for extremely preterm infants to improve long-term respiratory health.