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Published on: December 5, 2025
Non-invasive high-frequency oscillatory ventilation in preterm infants: a randomised controlled cross-over trial
Daniel Klotz1, Hendryk Schneider1, Stefan Schumann2
1Department of Neonatology, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Objective:
Non-invasive high-frequency oscillatory ventilation (nHFOV) has recently been described as a novel mode of respiratory support for premature infants. This study was designed to determine whether nHFOV decreases CO2 partial pressure (pCO2) in premature infants more effectively than non-invasive continuous positive airway pressure (nCPAP).
Design:
Non-blinded prospective randomised controlled cross-over study.
Setting:
University Medical Center tertiary neonatal intensive care unit.
Patients:
26 premature infants of 27±2 weeks of gestational age after extubation or non-invasive surfactant treatment.
Interventions:
Infants were treated with 4 hours of nHFOV and 4 hours of nCPAP in a cross-over design. The sequence of the ventilation mode was randomly allocated.
Main Outcome Measures:
The primary outcome measure was pCO2 of arterial or arterialised blood 4 hours after commencing the respective mode of respiratory support. Secondary outcome criteria included events of apnoea and bradycardia, respiratory rate, heart rate, pain and/or discomfort, mean airway pressure, fraction of inspired oxygen and failure of non-invasive respiratory support.
Results:
pCO2 after 4 hours of nHFOV was similar compared with 4 hours of nCPAP (p=0.33). pCO2 was 54.8 (14.6) vs 52.7 (9.3) mm Hg mean (SD) for the nHFOV-nCPAP period (n=13) and 49.0 (8.1) vs 47.7 (9.5) mm Hg for the nCPAP-nHFOV period (n=13). There was no difference in any of the secondary outcome measures. nHFOV was terminated prematurely in five cases for predefined failure criteria (p=0.051).
Conclusions:
We could not demonstrate an increased carbon dioxide clearance applying nHFOV compared with nCPAP in this cohort of preterm infants.
Trial Registration Number:
DRKS00007171, results.
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