INTRODUCTION: There are no data in the surfactant era concerning early management of RDS with HFJV compared to conventional mechanical ventilation (CMV). We performed this prospective, randomized trial to assess outcomes among premature infants managed with either HFJV or CMV.

METHODS: Inclusion criteria: GA <33 weeks, BW 500-2000 gm, age< 24 hrs, assisted ventilation (PIP> 16, FiO2>0.30), and RDS on CXR. We used standard (not “high-volume”) HFJV strategy. Infants were randomized to either HFJV or CMV and treated with the assigned ventilator for at least 7 days unless extubated or meeting crossover criteria.RESULTS: 73 neonates were enrolled. Maternal, obstetrical, and perinatal characteristics in CMV- and HFJV-managed groups were similar. Various measures of PaCO2 were not independently related to adverse outcomes. There were no significant differences between groups in pH, oxygenation, mean arterial blood pressures, or cerebral Doppler blood flow velocities. Treatment with HFJV was independently significantly associated with both CPVL (OR [95% CI] = 9.1 [1.6, 52.2]) and a poor outcome (OR = 3.8[1.2, 12.4]). Table

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CONCLUSION: Early treatment of RDS in preterm infants using standard-strategy high-frequency jet ventilation is associated with a greater risk for adverse outcomes. Supported by NIH 5RO1 HD21453-06.