Outcomes of infants with birthweights less than 501 g compared to infants weighing 501-750 g at a center utilizing first intention high frequency jet ventilation

Abstract

Background: Data on clinical outcomes of infants with birthweights less than 501 g (ELBW^<501) are limited.

Objective: To evaluate management strategies and clinical outcomes of ELBW^<501infants compared to infants weighing 501-750 g (ELBW^501-750).

Methods: A retrospective study of all ELBW^<501 and ELBW^501-750 infants born between 2012 and 2022 at a center utilizing first intention high frequency jet ventilation was performed. Patient characteristics, clinical and outcome data were compared between the two groups.

Results: A total of 358 infants (92 ELBW^<501 infants and 266 ELBW^501-750) were included. The survival rate for the ELBW^<501 group was 60.9% compared to 86.5% for ELBW^501-750. ELBW^<501 infants required more frequent use of 2.0 mm endotracheal tubes, required higher FiO₂ and longer duration of mechanical ventilation. Compared to ELBW^501-750 group, the ELBW^<501 group were more likely to be SGA (68.2% vs. 16.5%) and more premature (23.2 vs. 24.3 weeks) with lower survival, longer length of stay, higher incidence of ROP and lower weight at discharge but comparable rates of IVH, grade 3 BPD, discharged on supplemental oxygen, and tracheostomy.

Conclusion: ELBW^<501 infants are at risk for significant morbidity and mortality. However, with specialized obstetric and neonatal care, survival rates of 60% are possible with respiratory outcomes comparable to ELBW^501-750 infants. However, the increased risk of severe ROP for ELBW^<501 requiring either surgical or medical intervention is concerning and warrants optimal surveillance.

Keywords: HFJV - high-frequency jet ventilation; high frequency; neonatalogy; nutrition; survival.