High frequency oscillatory ventilation for the newborn: evidence versus practice in Australia and New Zealand

Bhuta T1 and Henderson-Smart DJ2

1.Dept.of Neonatology, Royal North Shore Hospital, Sydney, Australia

2.NSW Centre for Perinatal Health Services Research, Sydney, Australia

 

Aims: To review whether the increasing use of high frequency oscillatory ventilation (HFOV) in Australia and New Zealand is evidenced based.

Methods: Systematic reviews of HFOV were reviewed from the Cochrane Library. Results are reported as relative risk (RR) with 95% confidence intervals, and as number needed to treat (NNT) to produce an outcome. Data on the use of HFOV was obtained from the NSW Neonatal Intensive Care Study (NICUS) database (1992-99), The Australian and New Zealand Neonatal Network (ANZNN) in 1999.

Results: 1) Elective HFOV for preterm (<35 wks) infants with respiratory distress syndrome (RDS). 8 trials of 1649 infants. There was no difference in mortality, a significant reduction in CLD at 36 weeks [6 trials RR 0.72 (0.56, 0.93), NNT 13]. There was a significant increase in grade 3 or 4 intraventricular haemorrhage (IVH) [8 trials RR 1.34 (1.08, 1.67), NNT 20]. This review suggests that the harms might out-weigh the benefits. 2) Rescue HFOV in preterm infants (< 35 weeks): There was an increase in the rate of IVH of any grade with HFOV [RR 1.77 (1.06,2.96), NNT 6]. 3) Rescue HFOV in near term (>35 weeks) infants: There was no difference in any outcomes. In NSW there has been a ten-fold increase in its use in 1992-99 mainly in preterm infants. In ANZNN in 1999 387 preterm (<35) and 119 near term infants received HFOV (overall 12% of infants given IPPV).

Conclusions: Research is needed to understand the barriers that prevent the uptake of evidence into practice as evident from the increasing use of HFOV in NSW despite the concerns of significant adverse effects.

 

 
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