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Updated: Jan 3, 2026
Preclinical Development: Overview
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.
Insights
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.
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.
Background:
Assisted ventilation for extremely preterm infants (<28 weeks of gestation) has become less invasive, but it is unclear whether such developments in care are associated with improvements in short-term or long-term lung function. We compared changes over time in the use of assisted ventilation and oxygen therapy during the newborn period and in lung function at 8 years of age in children whose birth was extremely premature.
Methods:
We conducted longitudinal follow-up of all survivors of extremely preterm birth who were born in Victoria, Australia, in three periods - the years 1991 and 1992 (225 infants), 1997 (151 infants), and 2005 (170 infants). Perinatal data were collected prospectively, including data on the duration and type of assisted ventilation provided, the duration of oxygen therapy, and oxygen requirements at 36 weeks of age. Expiratory airflow was measured at 8 years of age, and values were converted to z scores for age, height, ethnic group, and sex.
Results:
The duration of assisted ventilation rose substantially over time, with a large increase in the duration of nasal continuous positive airway pressure. Despite the increase in the use of less invasive ventilation over time, the duration of oxygen therapy and the rate of oxygen dependence at 36 weeks rose, and airflows at 8 years of age were worse in 2005 than in earlier periods. For instance, for 2005 versus 1991-1992, the mean difference in the z scores for the ratio of forced expiratory volume in 1 second to forced vital capacity was -0.75 (95% confidence interval [CI], -1.07 to -0.44; P<0.001), and for 2005 versus 1997 the mean difference was -0.53 (95% CI, -0.86 to -0.19; P=0.002).
Conclusions:
Despite substantial increases in the use of less invasive ventilation after birth, there was no significant decline in oxygen dependence at 36 weeks and no significant improvement in lung function in childhood over time. (Funded by the National Health and Medical Research Council of Australia and the Victorian Government's Operational Infrastructure Support Program.).
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