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Archives of Disease in Childhood - Fetal and Neonatal Edition 1998;78:F195-F198; doi:10.1136/fn.78.3.F195
Copyright © 1998 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.
Arch Dis Child Fetal Neonatal Ed 1998;78:F195-F198 ( May )

Stress response and mode of ventilation in preterm infants

M W Quinn,a R C de Boer,a N Ansari,b J H Baumerb

a Department of Child Health Postgraduate Medical School Heavitree Exeter Devon EX2 5SQ, b Department of Child Health Derriford Hospital Plymouth

Correspondence to: Dr M W Quinn.


Accepted 28 October 1997

AIM---To assess the change in stress response in preterm babies changed from patient triggered ventilation (PTV) to conventional mandatory ventilation (CMV) and vice versa; to determine outcome in relation to stress hormone concentrations.
METHODS---A randomised controlled study was conducted in two district general hospital neonatal intensive care units. Thirty babies, treated initially with CMV, were randomly assigned to remain on CMV or to change to PTV. A second group of 29 babies, treated initially with PTV, were randomly assigned to remain on PTV or to change to CMV. The babies were less than 32 weeks of gestation, ventilated within 72 hours of birth, with clinical and radiological features compatible with respiratory distress syndrome (RDS). Stress hormone concentrations and clinical distress score were measured before and 20 minutes after allocation of mode of ventilation.
RESULTS---Babies changed from CMV to PTV had significantly reduced adrenaline concentrations (median change -0.4 nmol/l) compared with those who remained on CMV. There was no increase in adrenaline in babies changed from PTV to CMV. There were no significant changes in noradrenaline concentrations or clinical distress score. Babies who died had significantly higher adrenaline and noradrenaline concentrations than those who survived.
CONCLUSION---A change in mode of ventilation significantly reduces adrenaline concentrations. Raised catecholamine values are associated with a poor outcome.

Keywords: stress response; trigger ventilation; conventional ventilation; hormones

© 1998 by Archives of Disease in Childhood
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