Single center experience with first-intention high-frequency jet vs. volume-targeted ventilation in extremely preterm...

Area of Science:

• Neonatal Medicine
• Pediatric Respiratory Medicine
• Critical Care

Background:

• Bronchopulmonary dysplasia (BPD) is a significant complication in extremely preterm infants.
• High-frequency jet ventilation (HFJV) and volume-targeted ventilation (VTV) are used for respiratory support in neonates.
• The comparative effectiveness of first-intention HFJV versus VTV for BPD prevention is not fully established.

Purpose of the Study:

• To compare the incidence of BPD and other adverse outcomes between first-intention HFJV and VTV in extremely preterm infants.
• To investigate the association of HFJV with BPD in a subgroup of neonates with gestational age (GA) ≤26 weeks and oxygenation index (OI) >5.

Main Methods:

• Retrospective cohort study of neonates with GA ≤28 weeks between November 2020 and March 2023.
• Exposure: first-intention HFJV; Comparator: VTV.
• Subgroup analysis for neonates with GA ≤26 weeks and OI >5, adjusting for relevant clinical factors.

Main Results:

• No significant differences in BPD rates or other adverse outcomes were observed between HFJV and VTV groups overall.
• In the subgroup of neonates with GA ≤26 weeks and OI >5, HFJV was associated with significantly lower rates of BPD (50% vs. 83%, p=0.034).
• Adjusted analysis in this subgroup showed HFJV significantly associated with lower BPD (OR 0.21) and combined BPD or death (OR 0.18).

Conclusions:

• First-intention HFJV is associated with reduced rates of BPD in extremely preterm neonates (≤26 weeks GA) with significant respiratory compromise (OI >5).
• Further research is warranted to confirm these findings and optimize ventilation strategies for vulnerable neonates.