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New-born infants with severe hyaline membrane disease: radiological evaluation during high frequency oscillatory
T H Helbich1, C Popow, M Dobner
1Department of Radiology, University of Vienna (AKH), Währinger Gürtel, Austria.
Insights
High frequency oscillatory ventilation (HFOV) with exogenous surfactant (ES) improved outcomes for newborns with hyaline membrane disease (HMD). HFOV reduced lung disease severity, mortality, and ventilation duration compared to conventional ventilation (CV).
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Hyaline membrane disease (HMD) is a significant cause of respiratory distress in newborns.
- Exogenous surfactant (ES) therapy and mechanical ventilation are standard treatments for HMD.
- High frequency oscillatory ventilation (HFOV) is an alternative ventilatory strategy with potential benefits.
Purpose of the Study:
- To evaluate the impact of exogenous surfactant (ES) combined with high frequency oscillatory ventilation (HFOV) versus conventional mechanical ventilation (CV) on newborns with severe HMD.
- To assess radiological and clinical outcomes in HMD infants treated with HFOV and ES.
Main Methods:
- A matched cohort study comparing 18 newborns treated with ES and HFOV to 18 newborns treated with ES and CV.
- Infants had severe HMD (stages 3.5-4) and were matched for birth weight and disease severity.
- Radiological assessments (parenchymal opacities, interstitial emphysema, air leak, overinflation, BPD) and clinical variables (survival, ventilation duration, oxygen requirements) were analyzed up to 28 days.
Main Results:
- HFOV group showed significantly less generalized parenchymal opacities (GPO) and pulmonary interstitial emphysema (PIE) at 4 weeks.
- Fewer signs of bronchopulmonary dysplasia (BPD) were observed in the HFOV group.
- The HFOV group had lower mortality rates (5 vs. 13), shorter mechanical ventilation duration (15 vs. 23 days), and reduced inspiratory oxygen needs.
Conclusions:
- Treatment with exogenous surfactant and high frequency oscillatory ventilation leads to favorable radiological and clinical outcomes in newborns with HMD.
- HFOV offers advantages over conventional ventilation in managing severe HMD, reducing lung injury and improving survival.
- ES and HFOV represent an effective therapeutic strategy for severe HMD.
Objective:
The aim of our study was to determine the impact of treatment with exogenous surfactant (ES) and high frequency oscillatory ventilation (HFOV) on the radiological appearance and clinical course of hyaline membrane disease (HMD) in new-born infants.
Materials And Methods:
New-born infants (18) (median weight, 1010 g) with severe HMD (stages 3.5 and 4) who were treated with ES and HFOV were matched by birth weight and severity of disease with 18 new-born infants treated with ES and conventional mechanical ventilation (CV). Chest radiograms taken on days 1, 2/3, 4/5, 7, 14 and 28 were analyzed to check for the severity of generalized parenchymal opacities (GPO), local opacifications, pulmonary interstitial emphysema (PIE), gross air leak, general and localized overinflation, bronchopulmonary dysplasia (BPD) and clinical variables such as survival rates, duration of mechanical ventilation, mean airway pressure and inspired oxygen concentration.
Results:
At 4 weeks of age, new-born infants treated by HFOV had less severe GPO (median degree 1.5 vs. 3), less PIE (1 vs. 7 patients) and fewer signs of BPD (median BPD degree 1.5 vs. 2.6). The incidence of pneumothorax and of local opacifications were similar in both groups. New-born infants on HFOV had a lower mortality rate (5 vs. 13), needed fewer days of mechanical ventilation (median 15 vs. 23 days) and lower inspiratory oxygen concentrations (median FiO2 0.38 vs. 0.64).
Conclusion:
In new-born infants with HMD, treatment with ES and HFOV resulted in a favourable radiological and clinical outcome as compared to treatment with ES and CV.