VENTILATORY PUMP FAILURE IN PREMATURE NEWBORNS

Objective: To determine the prevalence of ventilatory pump failure in premature (<34 weeks gestation) infants. Design: Prospective clinical evaluation of all neonatal intensive care unit (NICU) admissions over a 12 month period in a large, university affiliated hospital. Subjects : A series of 421 consecutive inborn premature infant admissions to th e NICU. Methods: infants were followed for signs and symptoms of respi ratory distress and monitored closely for evidence of respiratory fail ure requiring intubation and assisted ventilation. The indications for intubation and assisted ventilation were reviewed, and three such ind ications were considered clear manifestations of ventilatory pump fail ure, that is, delivery room resuscitation with CXR negative for eviden ce of parenchymal lung disease [DR/CXR-], hypercapnia (P-aCO2>55 torr) [up arrow CO2], and apnea. Results: A total of 192 premature infants (47% of study sample) required intubation and assisted ventilation. Fa ilure of the ventilatory pump to sustain ventilation (DR/CXR-, up arro w CO2, apnea) accounted for 70 of these 192 (36%) premature infants. C onclusions: Ventilatory pump failure is a common clinical phenomenon i n premature infants. Intensified research on the mechanisms and treatm ent of ventilatory pump failure might benefit a significant number of such newborns. (C) 1994 Wiley-Liss, Inc.