Improved survival and neurodevelopmental outcome after prolonged ventilation in preterm neonates who have received antenatal steroids and surfactant.(Statistical Data Included)

Abstract

Aims--To assess survival and neurodevelopmental outcome following prolonged ventilation beyond 27 or 49 days of postnatal life in neonates treated with antenatal steroids and surfactant.

Methods--The medical records of 84 babies born in 1994--1996 requiring ventilation after 27 postnatal days at Liverpool Women's Hospital were reviewed to determine the duration of mechanical ventilation, survival, and neurodevelopmental outcome at 3 years of age.

Results--Fifty six babies were mechanically ventilated after 27 postnatal days but for less than 50 days; 48 (86%) survived to 3 years. Twenty six (54%) of the survivors had normal neurodevelopment at 3 years and seven (15%) had only mild disability. Twenty eight babies were ventilated after 49 postnatal days; 14 survived to 3 years. Five of these survivors were neurodevelopmentally normal at 3 years and two had mild disability.

Conclusions--Survival decreases with more prolonged ventilation. When antenatal steroids and postnatal surfactant are used, there appears to be improved survival and neurodevelopmental outcome in preterm babies who require prolonged ventilation.

(Arch Dis Child Fetal Neonatal Ed 2001;84:F194-F196)

Keywords: prolonged ventilation; preterm; neurodevelopmental outcome; survival

There are few reports on mortality and neurodevelopmental outcome in neonates after prolonged ventilation. Two studies [1 2] have shown length of ventilation to be a better predictor of long term intact survival than findings on cranial ultrasound scan. Wheater et al [1] reported high mortality (83%) and no neurodevelopmentally normal survivors in a cohort of 12 very low birthweight babies ventilated for 50 days or more, and 29% mortality (29% normal survivors at 18 months) for 35 babies ventilated for 28-40 days. Bozynski et al [2] found mechanical ventilation for more than 21 days to be significantly associated with poor performance on the Bayley Mental Development Index compared with intracranial haemorrhage in 159 surviving babies of less than 1200 guntil 18 months of age, when the difference was no longer significant. In addition, prolonged ventilation was associated with lower birth weight and gestational age. Overstreet et al [3] reported 35% mortality in 58 babies ventilated by day 60 of age. In contr ast, Luchi et al [4] found no significant correlation between duration of mechanical ventilation and adverse neurological outcome at 36 months in a cohort of 27 babies with a mean birth weight of 940 g and mean gestation of 27 postmenstrual weeks ventilated for 22-128 days (44% were normal at 3 years and 22% had major disability). The babies in these studies were all born in 1980-1992 and most of them were not treated with antenatal steroids or exogenous surfactant. More recently, Whitfield et al [5] reported functional outcome data for 115 children at school age with a birth weight of less than 800 g born in 1974-1985, …