Outcomes with Prolonged Ventilation 

Walsh MC, Morris BH, Wrage LA, et al. Extremely Low Birth weight Neonates with Protracted Ventilation: Mortality and 18-Month Neurodevelopmental Outcomes.  J Pediatr (June 2005); 146:798-804.  

Objective: To compare duration of ventilation to mortality and adverse neurodevelopmental outcomes among extremely low birth weight (ELBW; 501-1000 g) infants.        

Study design: Retrospective analysis of prospectively collected data from 5364 infants with a birth weight of 501 to 1000 g born at National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers from 1995 to 1998. The main outcome measures were survival, duration of mechanical ventilation, and neuro-developmental outcome.          

Results: Overall survival was 71%. The median duration of ventilation for survivors was 23 days; 75% were free of mechanical ventilation by 39 days, and 7% were ventilated for 60 days. Of those ventilated for 60 days, 24% survived without impairment. Of those ventilated for 90 days, only 7% survived without impairment. Of those ventilated 120 days, all survivors were impaired.
           
Conclusions: The prognosis for ELBW with protracted ventilation remains grim. The cohort who remain intubated have diminished survival and high rates of impairment. Parents of these infants should be informed of changes in prognosis as the time of ventilation increases.

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 Comments:  The strengths of his study include a huge sample size, a high percentage of long-term follow up evaluations, and standardized testing. The risk for neurodevelopmental impairment with ventilation >60 days (odds ratio 3.76) was similar to the risk from periventricular leukomalacia (OR = 3.72). In this study, postnatal steroids were not significantly associated with neuro-developmental impairment (OR 1.13; CI 0.91-1.40).  Do we need to re-think the value of postnatal steroids in light of the neurodevelopmental risks associated with prolonged ventilation?  ABK.