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High-frequency oscillatory ventilation during physiological-based cord clamping attenuates inflammation in preterm
Bianca C Benincasa1, Emma G Vandenberg2,3, Zoe Johnson2,3
1Programa de Pós-graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Archives of Disease in Childhood. Fetal and Neonatal Edition
|February 24, 2026
Summary
High-frequency oscillatory ventilation (HFOV) effectively aerates preterm lamb lungs with lower tidal volumes. This method reduces lung inflammation and injury compared to conventional mechanical ventilation (CMV).
Area of Science:
- Neonatal Physiology
- Respiratory Medicine
- Comparative Physiology
Background:
- Successful lung aeration at birth is critical for neonatal adaptation.
- Preterm infants are susceptible to mechanical ventilation-induced lung injury due to high tidal volumes.
- Early respiratory support strategies are crucial for preventing neonatal respiratory complications.
Purpose of the Study:
- To compare high-frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CMV) for initial respiratory support in preterm lambs.
- To assess HFOV's efficacy in promoting lung aeration and reducing inflammation and injury.
- To investigate the impact of HFOV initiated during physiological-based cord clamping (PBCC).
Main Methods:
- Preterm lambs were instrumented for physiological monitoring and allocated to HFOV, CMV, or unventilated control groups.
- Respiratory support was initiated using PBCC.
- Lung aeration was assessed using lung ultrasound (LUS), and postmortem lung tissues were analyzed for inflammation and injury markers.
Main Results:
- HFOV achieved effective respiratory stabilization with significantly lower tidal volumes (1.7±0.4 mL/kg) than CMV (6.2±1.5 mL/kg).
- LUS confirmed rapid lung aeration with HFOV.
- HFOV lungs showed significantly fewer inflammatory cells (CD45+, CD163+) and reduced expression of inflammatory/injury markers compared to CMV lungs.
Conclusions:
- HFOV initiated during PBCC effectively aerates preterm lamb lungs while minimizing inflammation and injury.
- These findings suggest HFOV as a potentially beneficial strategy for initial respiratory support in preterm neonates.
- HFOV may reduce lung inflammation during the critical transition to extrauterine life.
