Prognosis of very preterm infants with severe respiratory distress syndrome receiving mechanical ventilation.

objectiveTo evaluate the prognosis of very preterm infants with severe respiratory distress syndrome (RDS) receiving mechanical ventilation.

methodsA total of 288 preterm infants mechanically ventilated for severe RDS and completed follow-up till 18 months of corrected age comprised these study subjects. The associations of prenatal and postnatal factors, mode and duration of conventional mechanical ventilation (CMV), medication and treatment, and complications with cerebral palsy or mental developmental index (MDI) < 70 at 18 months of age were analyzed.

resultsThe incidences of CP among study subjects were 17, 5, and 2% in infants less than 28, 28-30, and 30-32 weeks, respectively. The incidences of MDI < 70 were 49, 24, and 13% in infants less than 28 weeks, 28-30 weeks, and 30-32 weeks, respectively. Antenatal corticosteroids, preeclampsia, fetal distress, early and late bacteremia, and decreased weight gain were associated with CP and an MDI < 70. In the CP and MDI < 70 groups, the number of infants on CMV was significantly higher than on high-frequency oscillatory ventilation (HFOV). Longer duration of mechanical ventilation and blood transfusions were associated with an increased risk of having an MDI < 70 or CP. The complications in study subjects associated with an MDI < 70 or CP were BPD, NEC, and IVH grade III-IV.

conclusionThe prognosis of very preterm infants with severe RDS may be influenced by several prenatal and postnatal factors. HFOV although decreased the duration of mechanical ventilation, whether it will decrease the incidence of neurodevelopmental disability, needs to be explored further.