Long Term Follow Up of VLBW Infants from a Neonatal Volume versus Pressure Mechanical Ventilation Trial

Abstract

Background: In a previous randomized trial, volume controlled ventilation (VCV) was noted to be efficacious in ventilating very preterm and extremely low birth babies.

Objective: To compare long term survival, pulmonary morbidities and gross neurodevelopmental outcomes of babies randomized to either VCV or Pressure Limited Ventilation (PLV) for treatment of RDS.

Design/methods: All surviving children were prospectively followed. Masked evaluation of health status, including frequency of respiratory illness such as cough and wheeze, use of medications, hospital admissions, and gross neurodevelopmental status was obtained using a structured parental questionnaire and verification from medical records.

Results: 94 of the 109 children (86%) survived to discharge. Three children died after discharge (VCV=2, PLV=1). Modality of ventilation did not affect overall mortality;7 in VCV group(12%) vs 11(21%) in the PLV group [OR 0.5 (0.1-1.4), p= 0.13]. Respiratory abnormalities were present in 32 (37%), and 26 (30%) required hospital readmission. There was no significant difference in readmission rates between the two groups; VC 13/45 (29%) and PLV 19/40 (47%) [OR 0.4 (0.1-1.1), p=0.07]. Modality of ventilation did not affect frequency of respiratory illness; VC 12(27%) PLV 14(35%) ( [OR 0.46 (0.1-1.1), p=0.09]. However, significantly fewer children in the VCV group (6 =13%) compared to PLV ( 13=32%) required treatment with inhaled steroids/bronchodilators [OR 0.3 (0.1-0.9, p=0.04]. Severe neurodevelopmental disability (cerebral palsy, blindness, or deafness) was present in 9 (9.8 %) (VCV= 3; PLV= 6) [OR 0.4 (0.09-1.7)].

Conclusions: The efficacy of VCV in very preterm and low birth babies appears to be maintained on longer term evaluation.