Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Volume guarantee pressure support ventilation in extremely preterm infants and neurodevelopmental outcome at 18 months

Journal of Perinatology volume 35, page 974 (2015)Cite this article

Subjects

Volume guarantee pressure support ventilation (VGPSV) improves neurodevelopmental outcomes by reducing the risk of severe intraventricular hemorrhage, periventricular leukomalacia (PVL), prolonged ventilatory support and hypocarbia.1 Stefanescu et al.2 have shown that VGPSV is associated with lower risk of short-term outcomes compared to pressure-controlled ventilation (PCV); however, there was no reduced risk of long-term neurodevelopmental outcomes in the VGPSV group. This study by Stefanescu et al. has only shown the factor of reduction in ventilation days, which could probably contribute to better neurodevelopmental outcomes; however, there is no significant statistical difference in the rates of intraventricular hemorrhage and PVL between the groups. Episodes of inadvertent hypocarbia should have been studied between the groups. Hypocarbia augments hypotension, and is associated with cystic PVL leading to worse neurodevelopmental outcomes.3 Whether there was any significant association of hypocarbia with the PCV group is not discussed in the study. The margin of this factor (i.e., hypocarbia) would have been limited if the clinicians managing the ventilation in the former epoch group (PCV epoch) had a tight control on the partial pressure of carbon-dioxide (PaCO2) levels while ventilating the infants, thus limiting its impact on the neurodevelopmental outcomes. Thus, it could be possible that there was no significant association of hypocarbia between the groups, which thus does not favor better neurodevelopmental outcomes in the VGPSV group.

Episodes of hypotension and its interventions could also affect neurodevelopmental outcomes.4, 5 There were fewer hypotensive episodes seen in the VGPSV group; this was attributed to stable tidal volume delivery minimizing the hemodynamic impact, which however was not proved. The authors also mentioned that it could also be due to the change in the clinician practices by the authors. Whether these fewer episodes of low blood pressure were truly because of change in practices or due to the effect of VGPSV on hemodynamics is unanswered. The authors should have compared the mean tidal volumes between the groups, which would help derive the conclusion of guaranteed and more stable tidal volume delivery in the VGPSV group, hence curtailing the impact of ventilation on hemodynamics. Alternatively, the effect of mode of ventilation on blood pressure, if studied during the same period with a controlled study design, would have limited the factor of changing practices over time and thereby established the cause−effect relationship.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Wheeler KI, Lingering C, Morley CJ, Davis PG . Volume-targeted versus pressure limited ventilation for preterm infants: a systematic review and meta-analysis. Neonatology 2011; 100 (3): 219–227.

    Article  Google Scholar 

  2. Stefanescu BM, Frewan N, Slaughter JC, O'Shea TM . Volume guarantee pressure support ventilation in extremely preterm infants and neurodevelopmental outcome at 18 months. J Perinatol 2015; 35 (6): 419–423.

    Article  CAS  Google Scholar 

  3. Giannakopoulou C, Korakaki E, Manoura A, Bikouvarakis S, Papageorgiou M, Gourgiotis D et al. Significance of hypocarbia in the development of periventricular leukomalacia in preterm infants. Pediatrics Int 2004; 46: 268–273.

    Article  Google Scholar 

  4. Batton B, Zhu X, Fanaroff J, Kirchner HL, Berlin S, Wilson-Costello D et al. Blood pressure, anti-comprehensive therapy, and development in extremely preterm infants. J Pediatr 2009; 154 (3): 351–357.

    Article  Google Scholar 

  5. Fanaroff JM, Wilson-Costello DE, Newman NS, Montpetite MM, Fanaroff AA . Treated hypotension is associated with neonatal morbidity and hearing loss in extremely low birth weight infants. Pediatrics 2006; 117 (4): 1131–1135.

    Article  Google Scholar 

  6. Shah DK, Doyle LW, Anderson PJ, Bear M, Daley AJ, Hunt RW et al. Adverse development in preterm infants with postnatal sepsis or necrotizing enterocolitis is mediated by white matter abnormalities on magnetic resonance imaging at term. J Pediatr 2008; 153 (2): 170–175.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Manipal Hospital, Bangalore, India

    A Razak

Authors
  1. A Razak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Razak.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Razak, A. Volume guarantee pressure support ventilation in extremely preterm infants and neurodevelopmental outcome at 18 months. J Perinatol 35, 974 (2015). https://doi.org/10.1038/jp.2015.118

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2015.118

This article is cited by

Search

Advanced search

Quick links