One of the toughest hurdles that premature babies must overcome is breathing. The respiratory system is one of the last to be developed during gestation so preemies almost always require breathing support in a neonatal intensive care unit (NICU) until their own lungs can take over. A long-term study of high-frequency oscillatory ventilation (HFOV) shows less damage to preemie lungs in the NICU and better breathing ability during adolescence than when conventional ventilation was used. School performance was enhanced, too.
The study was conducted in the United Kingdom, where approximately 60,000 preemies are born each year. The research team followed 319 children born before week 29 of gestation into adolescence, when each child was 11 to 14 years old.
In the NICU of London's King's College Hospital, each baby was randomly assigned HFOV or conventional ventilation:
- HFOV involves short, small bursts of oxygen.
- Conventional ventilation delivers oxygen in sync with the preemie's breathing rate.
Previous studies suggested HFOV might generate more lung damage than conventional ventilation, thereby leading to added respiratory distress in the NICU and after discharge. The King's College Hospital study did not find this to be the case.
Other studies mention the potential that HFOV might increase the risk of bleeding in the brain but the King's College study found no significant difference in the occurrence of bleeding into the brain regardless of which ventilation method was used. The UK research team found no evidence of adverse neurological effect in the NICU or in adolescence.
As adolescents, the children who received HFOV as a newborn were found to have superior lung function over their counterparts who received conventional ventilation. Of particular note was the ability of the HFOV kids to breathe out more easily than those who got conventional ventilation.
Input from the schoolteachers of the adolescents was included in the study. The teachers were asked to complete a questionnaire that was used to measure academic achievement of all the children in the study. The children who had HFOV were shown to have superior academic development over their study group peers in eight school subjects. The most notable difference was how well the HFOV children performed in three topics, specifically:
- Art and design
- Information technology and design
- Technologies that require spatial and visual abilities
The research team suggests the results of their study could lead to changes in the standard neonatal respiratory support procedures in hospitals across the UK. Dr. Anne Greenough, a professor of clinical respiratory physiology at King's College Hospital and member of the research team, says "Poorer lung function in adolescence could have further consequences later in life, such as making children more vulnerable to the damaging effects of smoking and infection."
Source: Greenough, Anne, et al. "Late Outcomes of a Randomized Trial of High-Frequency Oscillation in Neonates." The New England Journal of Medicine. Massachusetts Medical Society. Mar 20, 2014. Web. Mar 30, 2014.