Late outcomes of a randomized trial of high-frequency oscillation in neonates.

BACKGROUND: Results from an observational study involving neonates suggested that high-frequency oscillatory ventilation (HFOV), as compared with conventional ventilation, was associated with superior small-airway function at follow-up. Data from randomized trials are needed to confirm this finding. METHODS: We studied 319 adolescents who had been born before 29 weeks of gestation and had been enrolled in a multicenter, randomized trial that compared HFOV with conventional ventilation immediately after birth. The trial involved 797 neonates, of whom 592 survived to hospital discharge. We compared follow-up data from adolescents who had been randomly assigned to HFOV with follow-up data from those who had been randomly assigned to conventional ventilation, with respect to lung function and respiratory health, health-related quality of life, and functional status, as assessed with the use of questionnaires completed when the participants were 11 to 14 years of age. The primary outcome was forced expiratory flow at 75% of the expired vital capacity (FEF75). RESULTS: The HFOV group had superior results on a test of small-airway function (z score for FEF75, -0.97 with HFOV vs. -1.19 with conventional therapy; adjusted difference, 0.23 [95% confidence interval, 0.02 to 0.45]). There were significant differences in favor of HFOV in several other measures of respiratory function, including forced expiratory volume in 1 second, forced vital capacity, peak expiratory flow, diffusing capacity, and impulse-oscillometric findings. As compared with the conventional-therapy group, the HFOV group had significantly higher ratings from teachers in three of eight school subjects assessed, but there were no other significant differences in functional outcomes. CONCLUSIONS: In a randomized trial involving children who had been born extremely prematurely, those who had undergone HFOV, as compared with those who had received conventional ventilation, had superior lung function at 11 to 14 years of age, with no evidence of poorer functional outcomes. (Funded by the National Institute for Health Research Health Technology Assessment Programme and others.).

Viral lower respiratory tract infections and preterm infants' healthcare utilisation.

UNLABELLED: The aim of this study was to determine whether respiratory syncytial virus (RSV) and other viral lower respiratory tract infections (LRTI) in prematurely born infants were associated with similar effects on healthcare utilisation and related cost of care in the second compared to the first year after birth. Thirteen infants who had RSV LRTIs (RSV), 21 who had other viral LRTIs (other viral) and 25 had no viral LRTIs (no LRTI) were prospectively followed. Nasopharyngeal aspirates were collected whenever an infant had an LRTI regardless of whether it was in the hospital or in the community. Healthcare utilisation and the health-related cost of care were determined. Only the RSV group compared to the no LRTI group had higher overall respiratory costs in both year 1 (mean, £3,917 versus £24; p < 0.041) and year 2 (mean, £1,164 versus £61; p = 0.012). Only the RSV group required respiratory admissions; the RSV admission rate in year 2 was 3.4 % (number needed to treat 59). CONCLUSION: RSV LRTIs are associated with increased healthcare utilisation and cost of care in the first and second year; nevertheless, if prophylaxis is to be cost-effective in the second year, a high risk group needs to be identified.

Rhinovirus infection and healthcare utilisation in prematurely born infants.

Our aim was to determine whether rhinovirus (RV) lower respiratory tract infections (LRTIs) in prematurely born infants increase health-related cost of care during infancy. 153 infants born at <36 weeks of gestation were prospectively followed to 1 year. Cost of care was calculated from the National Health Service reference costing scheme and healthcare utilisation determined by examining hospital/general practitioner records. 20 infants developed RV LRTIs (RV group), 17 respiratory syncytial virus (RSV) LRTIs (RSV group), 12 both RV and RSV LRTIs (RV/RSV group) and 74 had no LRTI (no LRTI group). Compared with the no LRTI group, the RV/RSV LRTI group had the greatest increase in adjusted mean cost (difference GBP 5769), followed by the RV LRTI group (difference GBP 278) and, finally, the RSV LRTI group (difference GBP 172) (p=0.045). The RV group had more outpatient (p<0.05) and respiratory-related general practitioner (p<0.05) attendances, more wheezed at follow-up (p<0.001) than the no LRTI group and more had respiratory-related outpatient attendances than the RSV LRTI group (p<0.05). We conclude that RV LRTIs were associated with increased health-related cost of care during infancy; our results suggest that the RV group compared with the RSV group suffered greater chronic respiratory morbidity.

Risk for Complicated Immigration Transition: New Diagnosis for NANDA-International.

OBJECTIVE: The objective of this article is to describe the developmental processes for the creation of the new diagnosis risk for complicated immigration transition for the NANDA-I. METHODS: The study followed the recommended steps of developmental processes for NANDA-I. The identification of risk factors,which cause those who have migrated to feel vulnerable, is the result of two different research studies aimed at identifying nursing diagnosis related to the immigration process. RESULTS: A proposal of label, definition and risk factors of risk for complicated immigration transition. CONCLUSIONS: This new nursing diagnosis will reinforce the strategies for nursing interventions directed to empower immigrant people to acquire and/or develop the resources needed to cope with the immigration process.

Longitudinal assessment of lung function in extremely prematurely born children.

OBJECTIVES: To assess longitudinally small airway function in children born extremely prematurely and whether there was a correlation between airway function in infancy and at 11-14 years. WORKING HYPOTHESES: There would be tracking of airways obstruction and small airway function would deteriorate during childhood in those born extremely prematurely. STUDY DESIGN: A longitudinal study. PATIENT-SUBJECT SELECTION: Thirty-five children with a mean gestational age of 26 weeks had lung function assessed at 1 year corrected and 11-14 years of age. METHODOLOGY: Lung volumes were measured by helium gas dilution (FRCHe ) and plethysmography (FRCpleth ) and small airway function assessed by calculating the FRCHe :FRCpleth ratio. Airway function was assessed at 1 year corrected by measurement of airway resistance (Raw ) and at 11-14 years by assessment of Raw , forced expiratory flow from 75% of vital capacity (FEF75 ), and forced expiratory volume at one second (FEV1 ). RESULTS: At the first assessment, the children had a mean (SD) FRCHe :FRCpleth of 0.90 (0.13) and at the second, 0.83 (0.12) (P = 0.035). There was a significant 0.54% decrease (95%CI: -1.02%, -0.06%) in FRCHe :FRCpleth for increased age per year after adjusting for birth weight, gestational age, sex, and bronchopulmonary dysplasia (P = 0.027). There were significant correlations between Raw at the first assessment and Raw (P = 0.012), FEF75 (P = 0.034), and FEV1 (P = 0.04) at 11-14 years. CONCLUSIONS: These results demonstrate in those born extremely prematurely there is tracking of airway function during childhood.

United Kingdom Oscillation Study: long-term outcomes of a randomised trial of two modes of neonatal ventilation.

BACKGROUND: One in 200 infants in the UK is born extremely prematurely, i.e. before 29 weeks of gestation. Seventy-five per cent of such infants survive, but many have long-term respiratory and/or functional problems. OBJECTIVES: To compare respiratory and functional outcomes of school-age children born extremely prematurely who received either high-frequency oscillation (HFO) or conventional ventilation (CV) immediately after birth to test the hypothesis that the use of HFO would be associated with superior small airway function at school age without adverse effects. DESIGN: Follow-up of a randomised trial, the United Kingdom Oscillation Study, in which infants were randomised to receive HFO or CV within 1 hour of birth. SETTING: King's College Hospital NHS Foundation Trust, London, UK. PARTICIPANTS: Three hundred and nineteen children aged between 11 and 14 years were recruited (160 had received HFO); the planned sample size was 320. INTERVENTIONS: HFO versus CV. MAIN OUTCOME MEASURES: The results of comprehensive lung function assessments (primary outcome small airway function), echocardiographic examinations and respiratory, health-related quality of life and functional assessment questionnaires. RESULTS: Significant baseline differences in maternal and neonatal characteristics between the two groups favoured the CV group, who had a higher mean birthweight (56 g) and were born later (0.3 weeks), and a greater proportion of whom had received surfactant. There were no significant differences between the two groups in their characteristics when assessed at 11-14 years of age. The children who had received HFO had significantly superior small airway function; their forced expiratory flow at 75% vital capacity z-score was 0.23 higher than that of the CV group [95% confidence interval (CI) 0.02 to 0.45]. Thirty-seven per cent of the HFO group and 46% of the CV group had small airway function results that were below the tenth centile. There were significant differences between ventilation groups in favour of HFO for other lung function results as expressed by z-scores {forced expiratory volume at 1 minute (FEV1) [difference 0.35 (95% CI 0.09 to 0.60)], the ratio of FEV1 to forced vital capacity [0.58 (95% CI 0.16 to 0.99)], diffusing capacity of the lung for carbon monoxide [0.31 (95% CI 0.04 to 0.58)], maximum vital capacity [0.31 (95% CI 0.05 to 0.57)]} and expressed as % predicted {peak expiratory flow rate [5.85 (95% CI 2.21 to 9.49)] and respiratory resistance at 5 Hz [-7.13 Hz (95% CI -2.50 to -1.76 Hz)]}. There were no significant differences between ventilation groups with regard to the echocardiographic results, respiratory morbidity in the last 12 months, health problems, Health Utilities Index scores or Strengths and Difficulties Questionnaire (SDQ) scores. When SDQ scores were dichotomised, there was a significant finding for one subscale: a greater proportion of HFO children reported emotional symptoms. This finding was not replicated by parents' or teachers' reports. Two hundred and twenty-four teachers completed questionnaires regarding the children's educational attainment and provision. There were statistically significant differences in attainment in three subjects in favour of HFO: art and design, information technology, and design and technology. The HFO children had lower risk of receiving special education needs support [odds ratio 0.56 (95% CI 0.32 to 1.00)], but the difference was not significant. CONCLUSIONS: Follow-up at 11-14 years of age of extremely prematurely born infants entered into a randomised trial of HFO versus CV has demonstrated significant differences in lung function in favour of HFO. There was no evidence that this was offset by poorer functional outcomes; indeed, HFO children did better in some school subjects. It will be important to determine whether or not these differences are maintained after puberty as this is the last positive effect on lung function. TRIAL REGISTRATION: Current Controlled Trials ISRCTN98436149.