New-born infants with severe hyaline membrane disease: radiological evaluation during high frequency oscillatory versus conventional ventilation.
OBJECTIVE
The aim of our study was to determine the impact of treatment with exogenous surfactant (ES) and high frequency oscillatory ventilation (HFOV) on the radiological appearance and clinical course of hyaline membrane disease (HMD) in new-born infants.


METHODS
New-born infants (18) (median weight, 1010 g) with severe HMD (stages 3.5 and 4) who were treated with ES and HFOV were matched by birth weight and severity of disease with 18 new-born infants treated with ES and conventional mechanical ventilation (CV). Chest radiograms taken on days 1, 2/3, 4/5, 7, 14 and 28 were analyzed to check for the severity of generalized parenchymal opacities (GPO), local opacifications, pulmonary interstitial emphysema (PIE), gross air leak, general and localized overinflation, bronchopulmonary dysplasia (BPD) and clinical variables such as survival rates, duration of mechanical ventilation, mean airway pressure and inspired oxygen concentration.


RESULTS
At 4 weeks of age, new-born infants treated by HFOV had less severe GPO (median degree 1.5 vs. 3), less PIE (1 vs. 7 patients) and fewer signs of BPD (median BPD degree 1.5 vs. 2.6). The incidence of pneumothorax and of local opacifications were similar in both groups. New-born infants on HFOV had a lower mortality rate (5 vs. 13), needed fewer days of mechanical ventilation (median 15 vs. 23 days) and lower inspiratory oxygen concentrations (median FiO2 0.38 vs. 0.64).


CONCLUSIONS
In new-born infants with HMD, treatment with ES and HFOV resulted in a favourable radiological and clinical outcome as compared to treatment with ES and CV.
Helbich
T H
TH
Department of Radiology, University of Vienna (AKH), Währinger Gürtel, Austria.
Popow
C
C
Dobner
M
M
Wunderbaldinger
P
P
Zekert
M
M
Herold
C J
CJ
D001997:Bronchopulmonary Dysplasia / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D004338:Drug Combinations; D005233:Fatty Alcohols / Q000627:therapeutic use; D005260:Female; D006612:High-Frequency Ventilation; D006801:Humans; D006819:Hyaline Membrane Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D010767:Phosphorylcholine; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D011859:Radiography; D012121:Respiration, Artificial; D015996:Survival Rate; D016896:Treatment Outcome
D004338:Drug Combinations; D005233:Fatty Alcohols; D011663:Pulmonary Surfactants; D010767:Phosphorylcholine; D011092:Polyethylene Glycols; C047049:dipalmitoylphosphatidylcholine, hexadecanol, tyloxapol drug combination