Randomised trial of high frequency oscillatory ventilation or conventional ventilation in babies of gestational age 28 weeks or less: respiratory and neurological outcomes at 2 years

Marlow, N., Greenough, A., Peacock, J.L., Marston, L., Limb, E.S., Johnson, A.H. and Calvert, S.A. (2006) Randomised trial of high frequency oscillatory ventilation or conventional ventilation in babies of gestational age 28 weeks or less: respiratory and neurological outcomes at 2 years. Archives of Disease in Childhood. Fetal and Neonatal Edition, 91 (5), F320-F326. (doi:10.1136/adc.2005.079632).

Abstract

Background
The long term outcome of children entered into neonatal trials of high frequency oscillatory ventilation (HFOV) or conventional ventilation (CV) has been rarely studied.
Objective
To evaluate respiratory and neurodevelopmental outcomes for children entered into the United Kingdom Oscillation Study, which was designed to evaluate these outcomes.
Methods
Surviving infants were followed until 2 years of age corrected for prematurity. Study forms were completed by local paediatricians at routine assessments, and parents were asked to complete a validated neurodevelopmental questionnaire. Results: Paediatricians’ forms were returned for 73% of the 585 surviving infants. Respiratory symptoms were common in all infants, and 41% had received inhaled medication. Mode of ventilation had no effect on frequency of any symptoms. At 24 months of age, severe neurodevelopmental disability was present in 9% and other disabilities in 38% of children, but the prevalence of disability was similar in children who received HFOV or CV (relative risk 0.93; 95% confidence interval 0.74 to 1.16). The prevalence of disability did not vary by gestational age, but boys were more likely to have overall disability. Developmental scores were unaffected by mode of ventilation (relative risk 1.13; 95% confidence interval 0.78 to 1.63) and were lower in infants born before 26 weeks gestation compared with babies born at 26–28 weeks.
Conclusions
Initial mode of ventilation in very preterm infants has no impact on respiratory or neurodevelopmental morbidity at 2 years. HFOV and CV appear equally effective for the early treatment of respiratory distress syndrome. The effects of high frequency oscillatory ventilation (HFOV) and conventional ventilation (CV) on short term respiratory and neurological morbidity have been compared in several studies.1–10 Such short term observations may have poor predictive value for outcome in childhood, but to date only two reports have provided information about long term outcome. The HiFi trial evaluated respiratory morbidity and neurodevelopmental outcome up to 2 years of post-term age for 77% of survivors.11 Growth and clinical respiratory status did not differ between the two groups, but neurodevelopmental outcome was worse in the HFOV group, in keeping with the excess of major cranial ultrasound abnormalities identified in the original report. This study used a low volume HFOV strategy, which is now thought to be suboptimal in preterm infants with respiratory distress syndrome.

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