PEDIATRICS Vol. 46 No. 2 August 1970, pp. 193-202
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INDICATIONS FOR MECHANICAL VENTILATION IN INFANTS WITH HYALINE MEMBRANE DISEASE

E. O.R. Reynolds M.D., M.R.C.P.1

1 Department of Paediatrics, University College Hospital Medical School, London

One hundred and four infants with a diagnosis of hyaline membrane disease who weighed more than 1,000 gm at birth were admitted to the Neonatal Unit of University College Hospital during a period of 3 years. The management of the infants is described. Seventy-two infants survived without mechanical ventilation. The remaining 32 infants became apneic or collapsed with a heart rate of less than 80/minute, did not respond to simple resuscitative measures, and were mechanically ventilated; 7 of these 32 infants survived. Only one infant survived out of a total of 22 infants who became apneic within 24 hours of delivery. Six out of 10 infants survived when apnea occurred later than 24 hours after delivery. It is concluded that mechanical ventilation is unlikely to lead to the survival of the most severely affected infants, and that controlled trials of this form of treatment are both justifiable and desirable so that its effectiveness can be properly assessed.

Many infants with very severe abnormalities of gas exchange survived intact without needing mechanical ventilation. Therefore, it may be dangerous to select infants for mechanical ventilation on the basis of blood gas criteria because they may then be unnecessarily subjected to a potentially hazardous procedure.

Submitted on January 15, 1970
Accepted on February 20, 1970