Prolonged ventilation and intact survival in very low birth weight infants.
A requirement for prolonged ventilation (>28 days) has been associated with a poor outcome in infants. We postulated that in the present population of infants who usually receive antenatal steroids and post-natal surfactant, prolonged ventilation in discrete episodes, i.e. discontinuous intermittent positive pressure ventilation (IPPV), would have a better outcome than a requirement for prolonged ventilation continuously from birth (continuous IPPV) and, in addition, that an abnormal ultrasound scan appearance would be a reliable predictor of poor outcome in infants requiring prolonged ventilation. All very low birth weight (VLBW) infants ventilated for at least 28 days (prolonged ventilation) were identified from a prospectively maintained database. At 1 year of age, neurodevelopmental status was assessed and abnormal neurodevelopmental outcome diagnosed if the infant's Griffiths developmental quotient was at least two standard deviations below the mean and/or they had impairment with disability. Of 417 VLBW infants, 41 required prolonged ventilation (30 continuous and 11 discontinuous). In the continuous IPPV group, 18 and one in the discontinuous IPPV group died or had abnormal neurodevelopmental outcome ( P<0.01). All eight infants with major cranial ultrasound abnormalities died or had abnormal outcome ( P<0.01).


CONCLUSIONS
prolonged ventilation can be associated with intact survival, but not in very low birth weight infants with evidence of significant brain injury.
Thomas
Mark
M
Department of Child Health, King's College Hospital, London SE5 9RS, United Kingdom.
Greenough
Anne
A
Morton
Margaret
M
D016009:Chi-Square Distribution; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology*; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007385:Intermittent Positive-Pressure Ventilation / Q000009:adverse effects*; D009043:Motor Activity / Q000502:physiology; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D018709:Statistics, Nonparametric