High-frequency oscillatory ventilation May Lower BPD Risk in Preterm Infants: JAMA
Researchers have found in a new study that high-frequency oscillatory ventilation (HFOV) may reduce the incidence of bronchopulmonary dysplasia (BPD) compared to conventional mechanical ventilation (CMV) in infants born at ≤34 weeks’ gestation with neonatal respiratory distress syndrome (NARDS). The study was published in JAMA Network Open by Jie Li and fellow researchers.
The design of this single-center randomized clinical trial was carried out from August 1, 2019, to December 31, 2023, and included preterm infants born between 25 weeks 0 days and 34 weeks 6 days of gestation with a diagnosis of NARDS and initial clinical stability on CMV ventilation. A total of 386 infants were included in this clinical trial, with 181 infants randomized to elective HFOV and 205 infants continuing CMV ventilation. Data analysis was carried out between October and December 2024.
The primary outcome of this clinical trial was to examine the rate of BPD, with BPD defined by both a 2001 research-based Eunice Kennedy Shriver NICHD definition and a 2019 research-based definition. Secondary outcomes of this clinical trial included mortality, retinopathy of prematurity > stage 2, necrotizing enterocolitis > stage 2, intraventricular hemorrhage > grade 3, air leak, and hemodynamically significant patent ductus arteriosus. The analyses of this clinical trial included modified Poisson regression, ordinal regression, and Cox proportional hazards models.
Key findings:
In this study, there were 386 infants enrolled, of which 59.6% (230) were male, and the mean maternal age was 29.9 ± 4.8 years.
A total of 154 (39.9%) infants developed BPD based on the 2001 criteria, and 83 (21.5%) infants developed BPD based on the 2019 criteria.
Using elective HFOV, there was a significant reduction in BPD compared with CMV ventilation.
Using the 2001 criteria, BPD was reduced from 44.9% in the CMV group to 34.3% in the HFOV group, a reduction of 8.0% and a relative risk of 0.92 (95% CI, 0.86 to 0.99).
Using the 2019 criteria, BPD was reduced from 25.4% in the CMV group to 17.1% in the HFOV group, a reduction of 32.0% and a relative risk of 0.68 (95% CI, 0.45 to 1.00).
There was no statistically significant difference between the HFOV and CMV groups with respect to secondary outcomes, including death, ROP ≥ stage 2, necrotizing enterocolitis ≥ stage 2, grade 3 or higher IVH, air leak, and hemodynamically significant PDA.
Sensitivity analyses excluding 44 crossover infants from both groups also supported this study’s findings.
The use of elective HFOV reduced the incidence of bronchopulmonary dysplasia in preterm infants with NARDS without increasing adverse outcomes, supporting its potential as a preferred ventilation strategy in this high-risk group.
Reference:
Li J, Liu K, Yang Q, 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. doi:10.1001/jamanetworkopen.2026.0268
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