HIGH-frequency oscillatory ventilation (HFOV) may reduce the risk of bronchopulmonary dysplasia in preterm infants with neonatal acute respiratory distress syndrome, according to findings from a randomised clinical trial comparing high-frequency oscillatory ventilation with conventional mechanical ventilation.
Neonatal acute respiratory distress syndrome is a serious breathing condition that affects premature infants whose lungs are not fully developed. Many babies require mechanical ventilation to support breathing, but prolonged ventilator use can contribute to bronchopulmonary dysplasia, a chronic lung disease linked to long-term respiratory complications and increased mortality.
HFOV Ventilation Compared with Conventional Ventilation
In the study, researchers evaluated whether HFOV ventilation could improve outcomes compared with conventional mechanical ventilation in preterm infants diagnosed with neonatal acute respiratory distress syndrome. High-frequency oscillatory ventilation delivers very small breaths at rapid frequencies, aiming to maintain lung expansion while minimising injury to fragile lung tissue.
The randomised clinical trial enrolled 386 preterm infants born at or before 34 weeks’ gestation who were initially stabilised using conventional mechanical ventilation. Participants were then randomly assigned either to continue conventional ventilation or to transition to elective HFOV.
Lower Rates of Bronchopulmonary Dysplasia
The primary outcome was the development of bronchopulmonary dysplasia, assessed using two widely used clinical definitions. Overall, nearly 40% of infants met the older 2001 definition of the condition, while just over one fifth met the more recent 2019 definition.
Infants treated with HFOV experienced lower rates of bronchopulmonary dysplasia compared with those who remained on conventional ventilation. According to the earlier definition, HFOV reduced the risk by about 8%. Using the newer definition, which more strictly categorises disease severity, the reduction reached 32%.
No Increase in Other Serious Complications
Importantly, the study found no significant differences between the two ventilation strategies in several other major neonatal outcomes. These included death, severe retinopathy of prematurity, necrotising enterocolitis, severe intraventricular haemorrhage, air leaks in the lungs, and haemodynamically significant patent ductus arteriosus.
Sensitivity analyses excluding infants who switched treatment groups during the trial produced similar findings, supporting the robustness of the results.
Implications for Neonatal Care
Bronchopulmonary dysplasia remains one of the most common chronic lung conditions affecting extremely preterm infants. By reducing lung injury during respiratory support, HFOV ventilation may offer a potential strategy for lowering the risk of this condition.
Although the findings come from a single-centre study, the results suggest that early use of high-frequency oscillatory ventilation could help prevent more severe forms of bronchopulmonary dysplasia in infants with neonatal acute respiratory distress syndrome. Further studies will help determine how broadly this approach could be applied in neonatal intensive care units.
Reference
Li J et al. High-frequency oscillation vs mechanical ventilation for neonatal acute respiratory distress syndrome: a randomized clinical trial. JAMA Netw Open. 2026;9(3):e260268.
Featured image: Lavizzara on Adobe Stock
