Mortality Risk Factors in Preterm Infants Treated With High-Frequency Jet Ventilation

Abstract

Background: High-frequency jet ventilation (HFJV) has been used in conjunction with conventional ventilation (CV) for premature infants with respiratory failure. We sought to identify parameters that were associated with mortality in subjects who underwent HFJV. Methods: An IRB approved single-center retrospective review was conducted on subjects who received HFJV between 01/2015-01/2019. Subjects were enrolled if birth weight ≤ 2,000 grams and ≤ 34 weeks gestational age. Subjects were excluded if they received HFJV at time of admission with the aim of studying subjects who failed conventional ventilation. Ventilator parameters and laboratory data were extracted and analyzed prior to HFJV and at hours 1, 4, 6 and 12 following conversion. Subject demographics, including duration of ventilation, infection status, and inhaled nitric oxide usage were analyzed. Since the data were not normally distributed, they are presented as median (interquartile range). Mann-Whitney un-paired t-test was used to assess differences in continuous variables and the chi-square and Fisher exact test were used for categorical variables between the groups. Results: Fifty-three premature subjects, (n = 37 male) were studied. Prior to HFJV, PEEP was lower in non-survivors (5 cm H₂O vs. 6 cm H₂O, P = .18) and FIO₂ (.50 vs. .35, P = .049) was higher. Initial HFJV PIP (29 cm H₂O vs. 26 cm H₂O, P = .02); inhaled nitric oxide use (~8% vs. 4%, P = .04) and FIO₂ (.50 vs .34, P = .03) at 4-hours were higher in non-survivors. Non-survivors were more likely to be female (50% vs. 16%, P = .02); larger (1,200 grams vs. 800 grams, P = .04); and transitioned to HFJV at later postmenstrual age (29.5 weeks vs. 27.7 weeks, P = .04). Subject demographics and characteristics are displayed in Table 1. Conclusions: We identified that PMA, weight, initial HFJV PIP, FIO₂ and nitric oxide use were higher in non-survivors, and baseline PEEP was lower. These data may help to inform ventilation strategy and identify patients who are most likely to benefit from HFJV in the neonatal intensive care unit.

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* Postmenstrual age at time of HFJV † Duration of conventional ventilation prior to HFJV NEC = necrotizing entercolitis PDA = patent ductus arteriosus