High frequency oscillation in treatment of severe hyaline membrane disease and of persistent pulmonary hypertension of the newborn

Abstract

Between January 1986 and December 1988, 49 premature infants with severe hyaline membrane disease (HMD) and 28 premature and full-term infants with persistent pulmonary hypertension of the newborn (PPHN) were ventilated with high frequency oscillation (HFO) when conventional ventilation (CV) could no longer ensure sufficient blood oxygenation (PaO2<6,5 KPa despite an FiO2>0,6) before 12 hours of age. a) In the HMD group, the mean birth weight was 1300 g (range 720-2700 g) and the mean gestational age was 30 weeks (range 26-36 weeks). Thirty-five (71%) babies survived, and intercurrent complications during HFO were the following : pneumothoraces 26%, bronchopulmonary dysplasia 17%, intraventricular hemorrhage 26%, periventricular leukomalacia 6%, necrotizing enterocolities 9% and patent ductus arteriosus 6%. Mean PaO2/PAO2 raised from 0.10 before HFO to 0.26 at 24 hours and to 0.39 at 48 hours of age. b) In the PPHN group, 25 (89%) infants survived. HFO seems to be very effective in the treatment of infants with PPHN and to be encouraging in the treatment of HMD, but randomized controlled studies should be carried out to demonstrate that HFO improves survival in premature, infants with HMD.