The distinction between technological change and technological improvement is often obscure. Even apparently beneficial technologies may carry unexpected drawbacks. We wondered whether the introduction of HFOV into our NICU was associated with untoward events -- specifically, we wondered whether HFOV would prolong the hospital course of infants who ultimately died in our NICU.

Methods: We identified all infants who died in our institution for 2 years after introduction of optional HFOV in our NICU. We abstracted birthweight (b.w.), gestational age (g.a.), length of stay (LOS), and type of ventilation (CV vs HFOV) for all non-survivors. Recognizing that ethical considerations are sharpest at lower b.w., we parsed the data into birthweight groups above and below 1000g (ELBW).

Results: 103 infants died in our NICU after receiving mechanical ventilation during the two-year study period. 88 of these received CV exclusively, and 25 received HFOV primarily. There were no significant differences in b.w. or g.a. for ELBW infants receiving HFOV (median 654 g, 24.5 weeks) vs CV (median 644 g, 24 weeks). However, median LOS for ELBW non-survivors ventilated with HFOV was 20 days; quartiles 10 - 20 days, significantly longer than median LOS for CV non-survivors, 3 days, quartiles 1- 11 days (p < 0.05). For non-ELBW infants, the pattern held. Median LOS was significantly longer comparing HFOV vs CV non-survivors (17 days vs 3 days).

Conclusions: 1) Introduction of HFOV prolonged the dying of non-surviving newborns independent of initial mortality risk. 2) Significant benefits of HFOV will need to be demonstrated to offset this unhappy phenomenon.