title: First intention high-frequency oscillatory and conventional mechanical ventilation in premature infants without antenatal glucocorticoid prophylaxis.
abstract: OBJECTIVE
  Data comparing the effectiveness of high-frequency oscillatory ventilation and of conventional mechanical ventilation in the treatment of respiratory distress syndrome of very low birth weight infants are, to date, still matter of debate. We investigated the effects of first intention high-frequency oscillatory ventilation or conventional mechanical ventilation support on selected primary and secondary outcomes in very low birth weight infants complicated by respiratory distress syndrome in which antenatal glucocorticoid prophylaxis was not performed.
  
  
  METHODS
  Multicenter randomized control trial.
  
  
  METHODS
  Three tertiary centers of neonatal intensive care units from December 2004 to December 2007.
  
  
  METHODS
  Eighty-eight very low birth weight infants complicated by respiratory distress syndrome, without antenatal glucocorticoids, supported by first intention high-frequency oscillatory ventilation (n = 44) or conventional mechanical ventilation (n = 44).
  
  
  METHODS
  All newborns were monitored by standard monitoring procedure, including routine laboratory variables, neurologic patterns, and ultrasound imaging. Primary outcomes were: the length of ventilatory support, the need of reintubation, and the length of nasal continuous positive airway pressure support in the postextubation period. Secondary outcomes were: the length of stay in neonatal intensive care unit and in hospital, death before discharge, adverse short- and long-term pulmonary and neonatal outcomes, and the need for a second dose of surfactant and of postnatal glucocorticoid treatment.
  
  
  RESULTS
  High-frequency oscillatory ventilation infants showed a significant lower duration (p < .001 for all) of ventilator dependency, lower need of reintubation and of duration of nasal continuous positive airway pressure support in the postextubation period. Among secondary outcomes in the high-frequency oscillatory ventilation infants, the need of a second dose of surfactant administration, and the length of stay in the neonatal intensive care unit and in hospital were significantly lower (p < .05 for all).
  
  
  CONCLUSIONS
  We found that high-frequency oscillatory ventilation in very low birth weight infants without antenatal glucocorticoid prophylaxis reduced the need of ventilatory support, surfactant therapy, and reintubation, and shortened neonatal intensive care unit and hospital stay, thus reducing unit and hospital costs. These data would support the usefulness of first intention high-frequency oscillatory ventilation strategy in managing in a selected population, such as very low birth weight newborns complicated by severe respiratory distress syndrome not antenatally treated with glucocorticoids.
authors.affiliation: Department of Maternal, Fetal and Neonatal Medicine, University of Messina, Messina, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Salvo
authors.forename: Luc J
authors.initials: LJ
authors.lastname: Zimmermann
authors.forename: Antonio W
authors.initials: AW
authors.lastname: Gavilanes
authors.forename: Ignazio
authors.initials: I
authors.lastname: Barberi
authors.forename: Alberto
authors.initials: A
authors.lastname: Ricotti
authors.forename: Raul
authors.initials: R
authors.lastname: Abella
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giamberti
authors.forename: Pasquale
authors.initials: P
authors.lastname: Florio
authors.forename: Paolo
authors.initials: P
authors.lastname: Tagliabue
authors.forename: Lucia G
authors.initials: LG
authors.lastname: Tina
authors.forename: Francesco
authors.initials: F
authors.lastname: Nigro
authors.forename: Francesca
authors.initials: F
authors.lastname: Temporini
authors.forename: Diego
authors.initials: D
authors.lastname: Gazzolo
mesh_terms: D016001:Confidence Intervals; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006612:High-Frequency Ventilation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis; D016016:Proportional Hazards Models; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D011663:Pulmonary Surfactants