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

Neil Marlow ^1*, Anne Greenough ², Janet L Peacock ³, Louise Marston ³, Elizabeth Limb ⁴, Alice Johnson ⁴ and Sandy A Calvert ²

¹ University of Nottingham, United Kingdom
² Department of Child Health, United Kingdom
³ Brunel University, United Kingdom
⁴ St Georges Hospital Medical School, United Kingdom

^* To whom correspondence should be addressed. E-mail: neil.marlow{at}nottingham.ac.uk.

Accepted 8 April 2006

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. We have evaluated respiratory and neurodevelopmental outcomes for children entered in to the United Kingdom Oscillation Study, which was designed to evaluate these outcomes.

Methods: Surviving infants were followed until two 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 percent of the 585 surviving infants. Respiratory symptoms were common in all infants and 41 percent 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 percent and other disabilities in 38 percent of children, but the prevalence of disability was similar in children who received HFOV or CV (relative risk: 0.93; 95 percent confidence interval: 0.74, 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 percent confidence interval: 0.78, 1.63) and were lower in infants born before 26 weeks of gestation compared to babies born at 26-28 weeks.

Conclusion: Initial mode of ventilation in very preterm infants has no impact on respiratory or neurodevelopmental morbidity at two years. HFOV and CV appear equally effective for the early treatment of respiratory distress syndrome.

Keywords: Infant newborn, developmental outcome, high frequency ventilation, prematurity, randomised trial

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