[Comment to a Cochrane review. HFOV or conventional ventilation for newborn infants with severe respiratory failure]

The Cochrane review of the use of high frequency oscillatory ventilation in newborns more than 34 weeks gestation only included one randomized study and therefore gives an incomplete picture of the use of HFOV as rescue therapy for this patient group. The study was stopped prematurely due to difficulties in patient recruitment. There is a real need for more randomized studies but increasing use of HFOV has made these studies very difficult to perform. From the existing data routine use of HFOV in this patient group cannot be recommended. Experience of using HFOV in one Swedish tertiary care center during the years 1993-1998 is described. Eighty seven newborns were treated with HFOV rescue with 69 percent patient survival while 91 percent of the surviving infants were extubated directly to nasal continuous positive airway pressure. Intraventricular hemorrhage was seen in 9 patients.