2003 OPEN FORUM Abstracts
PULMONARY OUTCOME AT 6 YEARS OF AGE FOLLOWING RDS TREATED WITH EARLY HFOV USING LUNG RECRUITMENT
Dale Gerstmann MD, Kari Wood RN, Annie Miller OTR, Mike Steffen MS, Bob Ogden
RRT, Ronald Stoddard MD, Stephen Minton, MD. Neonatology, Utah Valley Regional
Medical Center, Provo, Utah.
Objective: In a previous multicenter clinical trial, we randomly assigned surfactant treated premature newborns with RDS to CV or to early treatment with HFOV (Pediatrics 1996;98:1044-51). Compared to CV treated control infants, neonates treated with HFOV using a strategy designed to recruit and maintain lung volume and minimize oxygen exposure had clinical evidence during initial hospitalization of improved pulmonary outcome and less lung injury. This report details the pulmonary function of these infants at 6 year follow-up. (Pediatrics 2001;107(3):1-7.)
Design: Patients were recruited from 81 local survivors who participated in the original study. They were evaluated for: FVC, FEV1, FEV1/FVC, FEF25-75, FEF50, PEF, FRC, TLC, VC and RV calculated as (TLC-VC). The single-breath CO technique was used to determine DLCO and VA. The ratio, VA/TLC was used as an index of maldistribution of inspired air.
Lung Volumes: TLC, VC, RV
Results: 87% of the cohort originally assigned to treatment with HFOV (N=36) or CV (N=33) were seen in follow-up at a mean age of 6.4 yr. The following significant differences (p<0.05) were found between the HFOV and CV treated groups (mn±sd):
TLC: 2.0±0.5 vs 2.47±0.7
FRC: 1.0±0.2 vs 1.5±0.8
RV: 0.5±0.4 vs 1.0±0.8
VC/TLC: 75±13 vs 59±19
RV/TLC: 25±13 vs 41±19
VA/TLC: 1.0±0.3 vs 0.8±0.2
Conclusion: Premature infants with established RDS who received surfactant replacement and were treated with CV had pulmonary function evidence of chronic lung disease at 6 years of age, while similar changes were not seen in those patients who were treated with early HFOV using a lung recruitment strategy.