RESCUE HIGH-FREQUENCY OSCILLATORY VENTILATION FOR PRETERM INFANTS - NEURODEVELOPMENTAL OUTCOME AND ITS PREDICTION

The role of rescue high-frequency oscillatory ventilation (HFO) in tre ating very-low-birth-weight neonates with severe respiratory failure i n relation to neurodevelopmental outcome has not been evaluated. We pe rformed a retrospective cohort study on 21 patients (out of 52 consecu tively admitted preterm neonates with gestational age less than or equ al to 30 weeks and birth weight less than or equal to 1:250 g; mortali ty rate 60%) rescued with HFO between October 1988 and August 1993. Ne urodevelopment, including Bayley Scales in Infant Development, was ass essed at 12-61 (mean 28.5) months adjusted age. Thirteen normal (score s better than 2 SD below mean, and no sensory or motor disability) (62 %) and neurodevelopmentally disabled children (38%) survived more than 1 year for developmental assessment. The mental and performance devel opmental indices were 94 (78-117) and 89 (68-110), and 63 (49-102) and 49 for the 13 normal and 8 disabled children, respectively (both p < 0.05). The incidence of bronchopulmonary dysplasia, intraventricular h emorrhage (IVH; grade 3 or 4), growth retardation, developmental score s and disabilities of these 21 HFO survivors were not significantly di fferent from that of a birth-weight- and gestational-age-matched compa rison group. While all HFO survivors had significant improvement in ox ygenation 12 and 24 h after starting HFO, FiO(2) and the alveolar-arte rial oxygen gradient (A-aDO(2)) decreased significantly Ih after start ing HFO in survivors with normal neurodevelopmental outcome. The lack of initial response to HFO (20% decrease in A-aDO(2) 1 h after startin g HFO) and the presence of grade 3 or 4 IVH predicted neurodevelopment al disability with a sensitivity of 63%, a specificity of 100%, and po sitive and negative predictive values of 100 and 81%, respectively. We concluded that HFO could be used as a rescue treatment in sick preter m neonates. The lack of early improvement in oxygenation and the prese nce of grade 3 or 4 IVH can predict adverse early childhood neurodevel opment in such neonates.