High-frequency oscillatory ventilation may reduce the incidence of bronchopulmonary dysplasia in neonatal respiratory distress syndrome

1. High-frequency oscillatory ventilation (HFOV) may reduce the incidence of bronchopulmonary dysplasia (BPD) compared with conventional mechanical ventilation (CMV) in infants born at 34 weeks’ gestation or earlier with neonatal respiratory distress syndrome (NARDS).

Evidence Rating Level: 1 (Excellent)

NARDS is a serious condition in premature infants and remains a leading cause of neonatal mortality. However, it is unclear if HFOV or CMV should be the preferred first-line therapy. A previous study found HFOV did not significantly reduce BPD risk compared with CMV in infants born between 24 and 42 weeks with NARDS, although subgroup analysis suggested benefit in infants born at 34 weeks or less. This single-center, single-blinded randomized controlled trial sought to compare the incidence of BPD in infants born between 25 weeks 0 days and 34 weeks 6 days and diagnosed with NARDS. Patients were initially stabilized with CMV and randomized to transition to HFOV (n = 181; mean [SD] age, 30.60 [2.42] weeks; 44.2% female) or continue with CMV (n = 205; mean [SD] age, 31.00 [ 2.42] weeks; 37.1% female). BPD was assessed using 2 definitions: 1) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); 2) Jensen et al, 2019. Overall, 154 (39.9%) and 83 (21.5%) developed BPD according to definitions 1 and 2, respectively. Elective HFOV reduced the risk of BPD by 8.0% (34.3% vs 44.9%; relative risk, 0.92; 95% CI, 0.86-0.99) according to definition 1 and by 32.0% (17.1% vs 25.4%; relative risk 0.68; 95% CI, 0.45-1.00) according to definition 2 compared with CMV. There were no significant differences in mortality, stage 2 or higher retinopathy of prematurity, stage 2 or higher necrotizing enterocolitis, or grade 3 or higher intraventricular hemorrhage. Overall, HFOV may reduce the incidence of BPD compared with CMV in infants born at 34 weeks’ gestation or earlier with NARDS.

Click here to read the study in JAMA Network Open

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