Outcome of Infants With Birth Weights Less Than 1000 g With Respiratory Distress Syndrome Treated With High-Frequency Ventilation and Surfactant Replacement Therapy

OBJECTIVE: To compare outcomes in premature infants with respiratory distress syndrome who received surfactant replacement therapy and were treated with either high-frequency or conventional mechanical ventilation. DESIGN: Retrospective chart review of patient series. SETTING: Tertiary academic medical center. PATIENTS: One hundred fourteen extremely low-birth-weight infants (< 1000 g) with respiratory distress syndrome treated with surfactant replacement therapy, consecutively admitted to the neonatal intensive care unit between September 1989 and August 1992. INTERVENTIONS: Treatment with either high-frequency ventilation (n = 46) or conventional mechanical ventilation (n = 68) after surfactant replacement therapy. MAIN OUTCOME MEASURES: Intraventricular hemorrhage and neurodevelopmental status. RESULTS: Infants who received high-frequency ventilation had significantly lower birth weights and were more premature than infants receiving conventional mechanical ventilation. Despite this, patients ventilated with high frequency had similar incidences of intraventricular hemorrhage and impaired neurodevelopmental outcomes when compared with the conventionally ventilated patients. As expected, the smaller and more premature infants receiving high-frequency ventilation required a longer duration of respiratory support (mechanical ventilation and nasopharyngeal continuous positive airway pressure). Additionally, multiple logistic regression analysis to control for differences in birth weight and gestational age between the two groups revealed a significant association between the combined use of high-frequency ventilation and antenatal corticosteroids and the absence of either intraventricular hemorrhage or pneumothorax. CONCLUSION: We conclude that high-frequency ventilation combined with surfactant therapy is as safe as conventional mechanical ventilation combined with surfactant therapy for treating respiratory distress syndrome in extremely low-birth-weight infants (< 1000 g) and does not increase the risk of either intraventricular hemorrhage or abnormal neurodevelopmental outcome.