Nasal high frequency oscillatory ventilation in extremely premature infants

Shows some promise as a primary mode of ventilation Respiratory distress syndrome is one of the most common problems in extremely preterm infants requiring treatment. The use of non-invasive modes of respiratory support has increased in neonatal intensive care units and led to a reduction in the incidence of ventilation induced lung injuries.1 However, after starting nasal continuous positive airway pressure (NCPAP) or nasal intermittent mandatory ventilation, a few newborns still need invasive ventilation. Interventions such as early rescue surfactant and golden hour care bundles (like good thermal care with cling wrap, targeted saturations, use of T-piece to deliver breaths gently, and others) have reduced this risk.2 Newer non-invasive modes like nasal high frequency oscillatory ventilation (NHFOV) and nasal neuronally adjusted ventilatory assist are showing promising outcomes in extremely preterm infants to reduce the risk further by better delivery of pressures into the lungs.1 In a linked study, Li and colleagues (doi:10.1136/bmj-2025-085569) report an important multicentre randomised trial evaluating the efficacy of NHFOV as primary respiratory support in extremely preterm infants with respiratory distress syndrome.3 In their trial, NHFOV is shown to be superior …