Effects of high-frequency oscillatory ventilation on brain injury in preterm infants with respiratory distress syndrome

Abstract

Objective To investigate the association between high-frequency oscillatory ventilation (HFOV) and the incidence of brain injury in premature infants(BIPI) with respiratory distress syndrome (RDS). Methods A total of 136 premature infants who were diagnosed as RDS and treated with mechanical ventilation between January 1, 2014 and June 30, 2016 were enrolled. After stratified by gestational age of 36-34 weeks, 33-32 weeks, 31-28 weeks and ≤27 weeks, the neonates were randomly divided into two groups (68 cases each): conventional mechanical ventilation (CMV) and HFOV groups. Duration of ventilation and changes in blood gas parameters following 24, 48 and 72 hours of ventilation were monitored and compared between the two groups. Incidences of BIPI and complications in the two groups were calculated and their associations with gestational age and birth weight were analyzed. Moreover, incidences of cure rates in the two groups were comparatively analyzed. Independent samples t-test, two-way analysis of variance, Chi-square test or Fisher's exact test was used for statistical analysis. Results (1)Significant difference was observed neither in the perinatal factors (prenatal glucocorticoid usage, and incidences of premature rupture of membrane and gestational diabetes mellitus), nor in the severity of RDS between the two groups (all P>0.05). (2) The average duration of ventilation in the CMV group was higher than that of the HFOV group [(68.4±10.3) vs (64.7±8.5) h, t=2.285, P 0.05). (3) Neither the incidence of hemorrhagic brain injury nor that of non-hemorrhagic brain injury showed any significant difference between the CMV and HFOV groups [36.8% (25/68) vs 39.7% (27/68); 16.2% (11/68) vs 14.7% (10/68), both P>0.05]. The total incidence of BIPI showed no significant difference [44.1%(30/68) vs 45.8%(33/68), χ2=0.266, P=0.606]. The smaller gestational age at birth and the lower birth weight, the higher incidence of BIPI, although no significant difference was shown in the incidence of BIPI when compared among different gestational age groups and different birth weight groups (all P>0.05). (4) The incidence of complications in the CMV group was higher than that in HFOV group [25.0%(17/68) vs 11.8%(8/68), χ2=3.970, P=0.044],while the cure rate of RDS was similar [94.1%(64/68) vs 95.6%(65/68), χ2=0.151, P=0.703]. Conclusions HFOV is a safe and reliable therapy for preterm infants with RDS. Compared with CMV, HFOV can shorten the duration of ventilation and reduce the incidence of complications without increasing the risk of BIPI. However, the cure rate of RDS is not increased by HFOV. Key words: Respiratory distress syndrome, newborn; High-frequency ventilation; Brain injuries; Cerebral hemorrhage; Infant, premature