Published online March 5, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. e860-e865 (doi:10.1542/peds.2006-2082)
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ARTICLE

Neuromotor Outcome at 2 Years of Very Preterm Infants Who Were Treated With High-Frequency Oscillatory Ventilation or Conventional Ventilation for Neonatal Respiratory Distress Syndrome

Patrick Truffert, MD, PhDa,b, Josefa Paris-Llado, PhDb, Benoît Escande, MDc, Jean-François Magny, MDd, Gilles Cambonie, MDe, Elie Saliba, MDf, Gérard Thiriez, MDg, Véronique Zupan-Simunekh, Thierry Blanc, MDi, Jean-Christophe Rozé, MDj, Gérard Bréart, MD, MSCb and Guy Moriette, MDk

a Department of Neonatology, Lille University Hospital, Lille, France
b INSERM U 149, Paris, France
c Department of Neonatology, Strasbourg University Hospital, Strasbourg, France
d Department of Neonatology, Institut de Puériculture, Paris, France
e Department of Neonatology, Montpellier University Hospital, Montpellier, France
f Department of Neonatology, Tours University Hospital, Tours, France
g Department of Neonatology, Besançon University Hospital, Besançon, France
h Department of Neonatology, Antoine Béclère University Hospital, Clamart, France
i Department of Neonatology, Rouen University Hospital, Rouen, France
j Department of Neonatology, Nantes University Hospital, Nantes, France
k Department of Neonatology, Cochin Port-Royal University Hospital, Paris, France

OBJECTIVE. In a previous multicenter, randomized trial, elective use of high-frequency oscillatory ventilation was compared with the use of conventional ventilation in the management of respiratory distress syndrome in preterm infants <30 weeks. No difference in terms of respiratory outcome was observed, but concerns were raised about an increased rate of severe intraventricular hemorrhage in the high-frequency ventilation group. To evaluate outcome, a follow-up study was conducted until a corrected age of 2 years. We report the results concerning neuromotor outcome.

METHODS. Outcome was able to be evaluated in 192 of the 212 infants who survived until discharge from the neonatal unit: 97 of 105 infants of the high-frequency group and 95 of 104 infants of the conventional ventilation group.

RESULTS. In the infants reviewed, mean birth weight and gestational age were similar in the 2 ventilation groups. As in the overall study population, the following differences were observed between the high-frequency ventilation group and the conventional ventilation group: lower 5-minute Apgar score, fewer surfactant instillations, and a higher incidence of severe intraventricular hemorrhage. At a corrected age of 2 years, 93 of the 97 infants of the high-frequency group and 79 of the 95 infants of the conventional ventilation group did not present any neuromotor disability, whereas 4 infants of the high-frequency group and 16 infants of the conventional ventilation group had cerebral palsy.

CONCLUSIONS. Contrary to our initial concern about the increased rate of severe intraventricular hemorrhage in the high-frequency ventilation group, these data suggest that early use of high-frequency ventilation, compared with conventional ventilation, may be associated with a better neuromotor outcome. Because of the small number of patients studied and the absence of any explanation for this finding, we can conclude only that high-frequency oscillatory ventilation is not associated with a poorer neuromotor outcome.

Key Words: prematurity • high-frequency ventilation • outcome • chronic lung disease • multicenter trial • intraventricular hemorrhage

Abbreviations: HFOV—high-frequency oscillatory ventilation • IVH—intraventricular hemorrhage • OR—odds ratio • CI—confidence interval • PVL—periventricular leukomalacia • CP—cerebral palsy

Accepted Oct 13, 2006.