title: Volume guarantee pressure support ventilation in extremely preterm infants and neurodevelopmental outcome at 18 months.
abstract: OBJECTIVE
  Compared with pressure-controlled ventilation (PCV), volume-targeted ventilation is associated with decreased neonatal complications, including the combined outcome of death or bronchopulmonary dysplasia. However, little is known about its effect on neurodevelopmental outcome. We evaluated the hypothesis that as compared with PCV, volume-targeted ventilation reduces the risk of the combined outcome of neurodevelopmental impairment or death in very low birth weight infants.
  
  
  METHODS
  We studied a cohort of extremely preterm infants managed with either volume guarantee pressure support ventilation (VGPSV; n=135) or PCV (n=135). Infants were evaluated at 18 months adjusted age with a standardized neurological examination and the Bayley Scales of Infant and Toddler Development-third edition. Logistic regression models were used to evaluate the association of ventilation mode and neurodevelopmental outcome.
  
  
  RESULTS
  Rates of pulmonary interstitial emphysema (odds ratio 0.6; 95% confidence limits: 0.4, 0.8), hypotension (odds ratio: 0.7; 95% confidence limits: 0.5, 0.9) and mortality (odds ratio 0.45; 95% confidence limits: 0.22, 0.9) were lower among infants treated with VGPSV. The infants in the VGPSV group had a significantly shorter duration on mechanical ventilation compared with infants in the PCV group (log-rank test P<0.01). Seventy percent (155/221) of survivors were evaluated at 18 months adjusted age. A trend towards benefit for the combined outcome of death or neurodevelopmental impairment was seen in the VGPSV group but did not reach statistical significance (odds ratio: 0.59; 95% confidence limits: 0.32, 1.08).
  
  
  CONCLUSIONS
  VGPSV was associated with a decreased risk of short-term complications but not long-term developmental impairment in this modest-sized cohort.
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: B M
authors.initials: BM
authors.lastname: Stefanescu
authors.affiliation: Department of Pediatrics, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: N
authors.initials: N
authors.lastname: Frewan
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Slaughter
authors.affiliation: Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: O'Shea
mesh_terms: D000328:Adult; D002658:Developmental Disabilities / Q000453:epidemiology*; D006801:Humans; D062071:Infant, Extremely Premature; D019102:Infant, Very Low Birth Weight; D007385:Intermittent Positive-Pressure Ventilation / Q000009:adverse effects / Q000379:methods*; D009422:Nervous System Diseases / Q000453:epidemiology*; D012189:Retrospective Studies; D013990:Tidal Volume; D055815:Young Adult