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South African Journal of Child Health

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A pilot study to determine whether external stabilisation of the chest wall reduces the need for mechanical ventilation in preterm infants

DE Ballot, PA Cooper, BJ Cory, J Mlandu, C Palmer

Abstract


Objectives. This was a pilot study to determine whether external stabilisation of the chest wall with a splint reduces the need for mechanical ventilation in preterm infants, within the first 7 days after study entry.
Design. This was a non-blinded prospective randomised controlled study. After consent was obtained, babies were randomised into a chest splint or control group.
Setting and time. The study was conducted in the neonatal units of Johannesburg and Chris Hani Baragwanath hospitals between January 2004 and December 2005.
Subjects. Preterm infants with a birth weight above 1 000 g with respiratory distress syndrome requiring more than 25%
supplemental oxygen to maintain oxygen saturation above 90% during the first day of life.
Outcome measures. The primary outcome measure was the need for mechanical ventilation within 7 days of study entry;
secondary outcome measures were survival at 30 days, air leak and intraventricular haemorrhage.
Results. There were 40 infants enrolled, 19 randomised to the chest splint group and 21 to the control group. Demographic characteristics were comparable, although the splint group required significantly more supplemental oxygen at enrolment. Four of the 19 infants in the splint group and 5 of the 21 controls required mechanical ventilation (not significant). There was no air leak in any of the study subjects during the study period. Twelve infants in each group had cranial ultrasound scans: there was one grade 3 intraventricular haemorrhage, one periventricular echodensity and one germinal matrix cyst in each group. Three of the 21 controls and 2 of the 19 splint group infants died within the first 30 days; no death was related to the chest splint. There were no local complications related to the chest splint, such as skin rash or pressure sores.
Conclusion. This small study did not demonstrate any reduction in the need for ventilation with the use of the chest splint. Use of the splint was not associated with any complications and therefore appears to be safe to use. Further studies with larger numbers are warranted.



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