New-born infants with severe hyaline membrane disease: radiological evaluation during high frequency oscillatory versus conventional ventilation

Objective: The aim of our study was to determine the impact of treatment wi th exogenous surfactant (ES) and high frequency oscillatory ventilation (HF OV) on the radiological appearance and clinical course of hyaline membrane disease (HMD) in new-born infants. Materials ann methods: New-born infants (18) (median weight, 1010 g) with severe HMD (stages 3.5 and 4) who were tr eated with ES and HFOV were matched by birth weight and severity of disease with 18 new-born infants treated with ES and conventional mechanical venti lation (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 (GP O), 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 ven tilation, mean airway pressure and inspired oxygen concentration. Results: At 4 weeks of age, new-born infants treated by HFOV had less severe GPO (me dian 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 ventilati on (median 15 vs. 23 days) and lower inspiratory oxygen concentrations (med ian FiO(2) 0.38 vs. 0.64). Conclusion: In new-born infants with HMD, treatm ent with ES and HFOV resulted in a favourable radiological and clinical out come as compared to treatment with ES and CV. (C) 1998 Elsevier Science Ire land Ltd. All rights reserved.