Prospective Randomized Multicenter Comparison of High-Frequency Oscillatory Ventilation and Conventional Ventilation in Preterm Infants of Less Than 30 Weeks With Respiratory Distress Syndrome

Background. Early use of high-fre- quency ventilation and exogenous surfactant is proposed as the optimal mode of ventilatory support in infants with respiratory distress syndrome. In very premature infants, we tested the hypothesis that high-frequency versus conventional ventilation could decrease exoge- nous surfactant requirements and improve pulmonary outcome, without altering the complication rate, includ- ing that of severe intraventricular hemorrhage. Methods. Preterm infants with a postmenstrual age of 24 to 29 weeks, presenting with respiratory distress syn- drome were randomly assigned to high-frequency oscil- latory ventilation (lung volume recruitment strategy) or conventional ventilation. Results. Two hundred seventy-three infants were en- rolled. One hundred fifty-three had a postmenstrual age of 24 to 27 weeks, and 143 had a birth weight 2 instillations of exogenous surfactant (30% vs 62%; odds ratio: .27; 95% confidence interval: .16 -.44) and no difference in pulmonary out- come. The incidence of severe intraventricular hemor- rhage was 24% in the high-frequency group and 14% in the conventional ventilation group (adjusted odds ratio: 1.50; 95% confidence interval: .68 -3.30). Conclusion. Early use of high-frequency oscillatory ventilation in very premature infants decreases exoge- nous surfactant requirements, does not improve the pul- monary outcome, and may be associated with an in- creased incidence of severe intraventricular hemorrhage. Pediatrics 2001;107:363-372; prematurity, high-frequency