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.