Introduction: The potential benefits and risks associated with the use of high frequency ventilation (HFV) in neonates and children has been debated. Most studies have been of limited size reducing statistical power and their results otherwise open to interpretation. The evaluation of the aggregate of published studies is confounded by small numbers of patients, different treatment strategies and differences in HFV devices.Purpose: To use a meta-analysis to determine the long term outcomes and adverse effects associated with one specific high frequency ventilator and its standard treatment strategy (SensorMedics 3100A HFOV). Methods: All randomized controlled trials of the 3100A that have been presented at national or international meetings were identified (6 studies, 591 patients). Prospectively identified measures were identified as Outcomes (survival at 30 days, survival without chronic lung disease, and survival without significant chronic lung disease), and Adverse Effects (air leak developed or worsened, severe air leak developed and significant neurological event). For preterm infants, chronic lung disease (CLD) was assessed at 36 weeks Postconceptional age, while 30 days Postnatal age was used as the end point for near term infants and children. The marker for neurological events was severe IVH in all neonates/infants and seizures in children. To permit analysis of effects of maturity (neonates vs. infants/children) and timing of intervention (early vs. rescue), the data from two studies required further stratification. The meta-analysis used determined the odd ratios and corresponding 95% confidence limits for each of the above measures as well as the homogeneity of outcomes among studies. Results: While the relative risk of each of the Outcomes reported in the individual studies varied, there was no statistically significant difference (non-homogeneity) delected among the studies. The odds ratio and corresponding confidence limits are reported below. They consistently support excellent outcomes associated with the 3100A. Note that an odds ratio less than 1.0 indicates an increased relative incidence associated with the 3100A. Table

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When analyzed with regard to maturity the odds ratio for survival and CLD were nearly identical and air leak risks were similar. Importantly there was no increased risk of severe IVH in the preterm group (odds ratio 1.00, CL.51-1.95). When the studies were stratified according to severity at 3100A intervention the odds ratios were similar, indicating comparable benefits of HFOV across severity strata. Conclusion: The 3100A HFOV, when used according to its standard treatment strategy in neonates, infants and children, improves their outcome and reduces barotrauma, without an increase in neurological adverse effects.