Childhood outcome after early high-frequency oscillatory ventilation for neonatal respiratory distress syndrome

Objective. In a previous multicenter controlled clinical trial, we randomly assigned surfactant-treated premature newborns with moderate to severe res piratory distress syndrome to early treatment with high-frequency oscillato ry ventilation (HFOV) or to conventional ventilation (CV). Compared with co ntrol infants who were treated with CV, neonates who were treated with HFOV using a strategy designed to recruit and maintain lung volume and minimize oxygen exposure had clinical evidence of improved pulmonary outcome and le ss lung injury. We report a follow-up study designed to determine whether c linical differences persisted between these study groups. Methods. Patients were recruited from 81 survivors at 1 center (Provo, Utah ) and evaluated for sociodemographic and health history, growth, mental dev elopment, motor proficiency, and pulmonary function. Results. Eighty-seven percent of the cohort who originally were assigned to treatment with HFOV (n = 36) or CV (n = 33) were seen in follow-up at a me an age of 77 months (6.4 years). There were no differences in the frequency of hospitalization, pulmonary illness, asthma, or disabilities. Growth, ve rbal IQ, and motor development were appropriate for age and not different b etween groups. Patients who initially were randomized to treatment with CV showed pulmonary function evidence of decreased peak expiratory flow, incre ased residual lung volume, and maldistribution of ventilation. Conclusion. Neurodevelopmental childhood outcome after early intervention H FOV was normal and not different compared with patients who were treated wi th CV. Surfactant replacement combined with early HFOV using a lung recruit ment strategy ameliorates the acute lung injury in respiratory distress syn drome that predisposes some preterm infants to develop chronic lung disease .