PEDIATRICS Vol. 107 No. 2 February 2001, pp. 363-372
Prospective Randomized Multicenter Comparison of High-Frequency Oscillatory Ventilation and Conventional Ventilation in Preterm Infants of Less Than 30 Weeks With Respiratory Distress Syndrome
Received Jun 2, 2000; accepted Sep 18, 2000.
,
,,
From the Departments of Neonatology of University Hospitals,
* Cochin Port-Royal, Paris, France; Strasbourg, France; § Institut de
Puériculture, Paris, France; Montpellier, France;
¶ Besançon, France; # Tours, France; ** Antoine
Béclère, Clamart, France; Lille, France; §§ Rouen,
France; || Nantes, France; ¶¶ Department of Radiology,
Saint-Vincent de Paul, Paris, France; and ## INSERM U 149, Paris,
France.
Background. Early use of high-frequency 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 exogenous surfactant requirements and improve pulmonary outcome, without altering the complication rate, including that of severe intraventricular hemorrhage.
Methods. Preterm infants with a postmenstrual age of 24 to 29 weeks, presenting with respiratory distress syndrome were randomly assigned to high-frequency oscillatory ventilation (lung volume recruitment strategy) or conventional ventilation.
Results. Two hundred seventy-three infants were enrolled.
One hundred fifty-three had a postmenstrual age of 24 to 27 weeks, and
143 had a birth weight 
1000 g. One hundred thirty-four infants were randomized at 142 minutes of life (median) to receive conventional ventilation (mean postmenstrual age at birth: 27. 6 ± 1.5 weeks; mean birth weight: 997 ± 245 g); and 139 infants were
randomized at 145 minutes of life to receive high-frequency ventilation
(mean postmenstrual age at birth: 27.5 ± 1.4 weeks; mean birth
weight: 976 ± 219 g).High-frequency ventilation, compared with conventional ventilation, was
associated with a twofold reduction in the requirement for 
2
instillations of exogenous surfactant (30% vs 62%; odds ratio: .27;
95% confidence interval: .16-.44) and no difference in pulmonary
outcome. The incidence of severe intraventricular hemorrhage 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 exogenous surfactant requirements, does not improve the pulmonary outcome, and may be associated with an increased incidence of severe intraventricular hemorrhage. Key words: prematurity, high-frequency ventilation, chronic lung disease, multicenter trial, intraventricular hemorrhage.
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