Presented at the Neonatal Society 2001 Autumn Meeting.

Johnson A¹, Limb E¹, Marston L¹, Peacock JL¹, Greenough A², Marlow N³, Calvert SA¹

¹ St. George’s Healthcare Trust, London
² King’s College Hospital, London
³ Queen’s Medical Centre, Nottingham.

Background: Despite the increasing use of high frequency oscillatory ventilation (HFOV) evidence for its role in the prevention of chronic lung disease (CLD) remains inconclusive. We therefore conducted a multicentre trial to determine whether early intervention with HFOV reduces mortality and CLD in newborn infants < 29 weeks gestation

Aims:
1.To assess whether early use of HFOV in infants < 29 weeks gestation reduces the incidence of death or CLD
2. To ensure that any short term benefits are not associated with an increase in long term respiratory or neurological morbidity

Methods: Preterm infants with a gestational age of 23 to 28 weeks were randomised within one hour of birth, to either conventional ventilation (CV) or HFOV. Randomisation was stratified by centre and by gestational age (23-25w; 26-28w)

Results: 804 babies entered the trial of which 404 received HFOV and 400 CV. The two groups were balanced for a range of pre-trial maternal and infant characteristics. The table below demonstrates there were no significant differences in the composite primary outcome (death or CLD, defined at 36 weeks postmenstrual age), or in the incidence of major cerebral lesions, between infants in either gestational age group.

In the two trial groups 9% and 8% of babies, respectively, reached failure criteria. There were also no differences in a range of other secondary outcome measures, including airleak.

Conclusions: Both HFOV and CV are equally effective in the early treatment of respiratory disease in very preterm infants. Follow up at two years is currently in progress.