High-frequency jet ventilation (HFJV) has been used in conjunction with conventional ventilation for premature infants with respiratory failure. We sought to identify parameters that were associated with mortality in subjects who underwent HFJV.
METHODS:
Subjects were enrolled if birthweight was ≤ 2,000 g and they were ≤ 34 weeks gestational age. Subjects were excluded if they received HFJV at the time of admission because we aimed to study subjects who failed conventional ventilation. Subject demographics, ventilator parameters, and laboratory data were extracted and analyzed. The Mann-Whitney U-test was used to assess differences in continuous variables, and the chi-square and Fisher exact tests were used for categorical variables between the groups. To assess variables that were predictive of mortality, we used both univariate and multivariate logistic regression analysis. Independent predictors of mortality were identified and used to create a multivariate risk score. Receiver operating characteristic curves were constructed to evaluate the predictive accuracy of the multivariate risk score.
RESULTS:
A total of 53 premature subjects (n = 37 male) were studied, of whom 39 (74%) survived to discharge or transfer back to referring hospital. In the univariate model, female sex, older gestational age, higher birthweight, HFJV peak inspiratory pressure at 1 h, and oxygen saturation index at 4 h were associated with mortality. In the final multivariate logistic regression model, female sex (odds ratio 4.1, 95% CI 1.2–19.8, P = .044), closed ductus arteriosus (odds ratio 7.7, 95% CI 1.3–39.5, P = .016), and oxygen saturation index > 5.5 (odds ratio 6.0, 95% CI 1.5–28.3, P = .02) were independent predictors of mortality.
CONCLUSIONS:
We identified that oxygen saturation index > 5.5 after 4 h of HFJV, female sex, and closed ductus arteriosus were independent predictors of mortality.
StollBJ, HansenNI, BellEF, WalshMC, CarloWA, ShankaranS, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993–2012. JAMA, 2015; 314(10):1039-1051.
2.
TracyMK, BerkelhamerSK. Bronchopulmonary dysplasia and pulmonary outcomes of prematurity. Pediatr Ann, 2019; 48(4):e148-e153.
3.
Committee on Fetus and Newborn; American Academy of Pediatrics. Respiratory support in preterm infants at birth. Pediatrics, 2014; 133(1):171-174.
4.
JensenEA. Prevention of bronchopulmonary dysplasia: a summary of evidence-based strategies. Neoreviews, 2019; 20(4):e189-e201.
5.
DargavillePA, GerberA, JohanssonS, De PaoliAG, KamlinCO, OrsiniF, DavisPG. for the Australian and New Zealand Neonatal Network. Incidence and outcome of CPAP failure in preterm infants. Pediatrics, 2016; 138(1):e20153985.
6.
MoyaFR, MazelaJ, ShorePM, SimonsonSG, SegalR, SimmonsPD, et al. Prospective observational study of early respiratory management in preterm neonates less than 35 weeks of gestation. BMC Pediatr, 2019; 19(1):147.
7.
ChawlaS, NatarajanG, ShankaranS, CarperB, BrionLP, KeszlerM, et al. Markers of successful extubation in extremely preterm infants, and morbidity after failed extubation. J Pediatr, 2017; 189:113-119.e112.
8.
Rojas-ReyesMX, Orrego-RojasPA. Rescue high-frequency jet ventilation vs conventional ventilation for severe pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev, 2015; 10:CD000437.
9.
CoolsF, OffringaM, AskieLM. Elective high frequency oscillatory ventilation vs conventional ventilation for acute pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev, 2015; 3:CD000104.
10.
PatelRM, KandeferS, WalshMC, BellEF, CarloWA, LaptookAR, et al. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med, 2015; 372(4):331-340.
WheelerCR, SmallwoodCD, O’DonnellI, GagnerD, Sola-VisnerMC. Assessing initial response to high-frequency jet ventilation in premature infants with hypercapnic respiratory failure. Respir Care, 2017; 62(7):867-872.
13.
EhrenkranzRA, WalshMC, VohrBR, JobeAH, WrightLL, FanaroffAA. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics, 2005; 116(6):1353-1360.
14.
JobeAH, BancalariE. Bronchopulmonary dysplasia. Am J Respir Crit Care Med, 2001; 163(7):1723-1729.
15.
ManleyBJ, DoyleLW, OwenLS, DavisPG. Extubating extremely preterm infants: predictors of success and outcomes following failure. J Pediatr, 2016; 173:45-49.
16.
EthawiYH, Abou MehremA, MinskiJ, RuthCA, DavisPG. High frequency jet ventilation vs high frequency oscillatory ventilation for pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev, 2016; 5:CD010548.
17.
StollBJ, HansenNI, BellEF, ShankaranS, LaptookAR, WalshMC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics, 2010; 126(3):443-456.
18.
TownselCD, EmmerSF, CampbellWA, HussainN. Gender differences in respiratory morbidity and mortality of preterm neonates. Front Pediatr, 2017; 5:6.
19.
ErdeveO, OkuluE, TuncG, CelikY, KayacanU, CetinkayaM, et al. An observational, prospective, multicenter study on rescue high-frequency oscillatory ventilation in neonates failing with conventional ventilation. PloS One, 2019; 14(6):e0217768.
20.
WillsonDF, ThomasNJ, MarkovitzBP, BaumanLA, DiCarloJV, PonS, et al. Effect of exogenous surfactant (calfactant) in pediatric acute lung injury: a randomized controlled trial. JAMA, 2005; 293(4):470-476.
21.
StewartDL, Dela CruzTV, DuncanSD, CookLN. Response to high frequency jet ventilation may predict the need for extracorporeal membrane oxygenation. Eur Respir J, 1996; 9(6):1257-1260.
22.
GolombekSG, YoungJN. Efficacy of inhaled nitric oxide for hypoxic respiratory failure in term and late preterm infants by baseline severity of illness: a pooled analysis of three clinical trials. Clin Ther, 2010; 32(5):939-948.
23.
ShahidS, DuttaS, SymingtonA, ShivanandaS. McMaster University NICU. Standardizing umbilical catheter usage in preterm infants. Pediatrics, 2014; 133(6):e1742-1752.
24.
de BritoCS, de BritoDV, AbdallahVO, Gontijo FilhoPP. Occurrence of bloodstream infection with different types of central vascular catheter in critically neonates. J Infect, 2010; 60(2):128-132.
25.
DeindlP, WaldhorT, UnterasingerL, BergerA, KeckM. Arterial catheterisation in neonates can result in severe ischaemic complications but does not impair long-term extremity function. Acta Paediatr, 2018; 107(2):240-248.
26.
RawatM, ChandrasekharanPK, WilliamsA, GuginoS, KoenigsknechtC, SwartzD, et al. Oxygen saturation index and severity of hypoxic respiratory failure. Neonatology, 2015; 107(3):161-166.
27.
DoreswamySM, ChakkarapaniAA, MurthyP. Oxygen saturation index, a noninvasive tool for monitoring hypoxemic respiratory failure in newborns. Indian Pediatr, 2016; 53(5):432-433.
28.
KhemaniRG, ThomasNJ, VenkatachalamV, ScimemeJP, BeruttiT, SchneiderJB, et al. Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury. Crit Care Med, 2012; 40(4):1309-1316.
29.
MuniramanHK, SongAY, RamanathanR, FletcherKL, KibeR, DingL, et al. Evaluation of oxygen saturation index compared with oxygenation index in neonates with hypoxemic respiratory failure. JAMA Netw Open, 2019; 2(3):e191179.
30.
KhalesiN, ChoobdarFA, KhorasaniM, SarviF, Haghighi AskiB, KhodadostM. Accuracy of oxygen saturation index in determining the severity of respiratory failure among preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med, 2019:1-6.
31.
MirzaH, GarciaJ, McKinleyG, HubbardL, SensingW, SchneiderJ, et al. Duration of significant patent ductus arteriosus and bronchopulmonary dysplasia in extremely preterm infants. J Perinatol, 2019; 39(12):1648-1655.
de WaalK, EvansN, van der LeeJ, van KaamA. Effect of lung recruitment on pulmonary, systemic, and ductal blood flow in preterm infants. J Pediatr, 2009; 154(5):651-655.
34.
de WaalKA, EvansN, OsbornDA, KluckowM. Cardiorespiratory effects of changes in end expiratory pressure in ventilated newborns. Arch Dis Child Fetal Neonatal Ed, 2007; 92(6):F444-F448.
35.
FajardoMF, ClaureN, SwaminathanS, SattarS, VasquezA, D’UgardC, et al. Effect of positive end-expiratory pressure on ductal shunting and systemic blood flow in preterm infants with patent ductus arteriosus. Neonatology, 2014; 105(1):9-13.
36.
NoonanM, TurekJW, DagleJM, McElroySJ. Intraoperative high-frequency jet ventilation is equivalent to conventional ventilation during patent ductus arteriosus ligation. World J Pediatr Congenit Heart Surg, 2017; 8(5):570-574.
37.
ValiP, LakshminrusimhaS, PelechA, UnderwoodM, IngF. Patent ductus arteriosus in preterm infants: is early transcatheter closure a paradigm shift?. J Perinatol, 2019; 39(11):1449-1461.
38.
NaultyCM, HornS, ConryJ, AveryGB. Improved lung compliance after ligation of patent ductus arteriosus in hyaline membrane disease. J Pediatr, 1978; 93(4):682-684.
39.
GerhardtT, BancalariE. Lung compliance in newborns with patent ductus arteriosus before and after surgical ligation. Biol Neonate, 1980; 38(1-2):96-105.
40.
LehenbauerDG, FraserCD3rd, CrawfordTC, HibinoN, AucottS, GrimmJC, et al. Surgical closure of patent ductus arteriosus in premature neonates weighing less than 1,000 grams: contemporary outcomes. World J Pediatr Congenit Heart Surg, 2018; 9(4):419-423.
41.
SzymankiewiczM, HodgmanJE, SiassiB, GadzinowskiJ. Mechanics of breathing after surgical ligation of patent ductus arteriosus in newborns with respiratory distress syndrome. Biology of the Neonate, 2004; 85(1):32-36.
42.
HeuchanAM, HunterL, YoungD. Outcomes following the surgical ligation of the patent ductus arteriosus in premature infants in Scotland. Arch Dis Child Fetal Neonatal Ed, 2012; 97(1):F39-F44.
43.
UlrichTJB, HansenTP, ReidKJ, BinglerMA, OlsenSL. Post-ligation cardiac syndrome is associated with increased morbidity in preterm infants. J Perinatol, 2018; 38(5):537-542.
ClymanRI, WickremasingheA, MerrittTA, SolomonT, McNamaraP, JainA, et al. Hypotension following patent ductus arteriosus ligation: the role of adrenal hormones. J Pediatr, 2014; 164(6):1449-1455.
46.
HsuKH, WongP, Ram KumarS, EvansJ, NooriS. Predictors of respiratory improvement 1 week after ligation of patent ductus arteriosus in preterm infants. J Pediatr, 2019; 205:49-54.
47.
AttarMA, DechertRE, DonnSM. Rescue high frequency ventilation for congenital diaphragmatic hernia. J Neonatal Perinatal Med, 2019; 12(2):173-178.
48.
AnvekarAP, ShahPS, NathanEA, DohertyDA, PatoleSK, SimmerKN. High frequency jet ventilation in preterm infants: experience from Western Australia. J Matern Fetal Neonatal Med, 2019; 32(17):2824-2829.
49.
FangJL, MaraKC, WeaverAL, ClarkRH, CareyWA. Outcomes of outborn extremely preterm neonates admitted to a NICU with respiratory distress. Arch Dis Child Fetal Neonatal Ed, 2020; 105(1):33-40.
