In reference to the article on elective high-frequency oscillatory ventilation (HFOV) published in the May issue [1] the following points need to be further addressed.

Firstly, as stated in the Introduction, the utility of HFOV in the management of hyaline membrane disease is no more considered as ‘controversial’. During the last 30 years there has been great debate about the best ventilatory mode in preterm infants in order to avoid short- and long-term complications. However, the current evidence including the Cochrane review and the meta-analysis of individual patients’ data in 2010 (3229 infants from 10 randomized controlled studies) provides no grounds to favor elective HFOV in preterm infants with acute pulmonary dysfunction [2,3]. The latter analysis also showed that the effect of HFOV (for outcomes including death, oxygen dependency, and neurological injury, alone or in combination) is similar across various birth weight, gestational age and ventilation strategy subgroups [3]. This means that elective HFOV has no definite advantage over optimally applied conventional ventilation (‘gentle ventilation’) in improving pulmonary outcome in neonates. This is despite animal studies demonstrating the beneficial effect of HFOV in oxygenation and lung recruitment, subsequently reducing ventilator-induced lung injury (VILI).

Finally, notwithstanding the fact that HFOV in preterm infants is as effective and safe as conventional ventilation, there is a need for studies specifically looking at the cost-effectiveness of HFOV because several studies in the past and the current study documented a significantly shorter duration of ventilation and hospital stay in HFOV [4,5]. Correspondingly, the recent meta-analysis showed that the age at extubation was lower for HFOV with some evidence suggesting discontinuation of continuous positive nasal airway pressure earlier with HFOV than with conventional ventilation [3].

1. Singh SN, Malik GK, Prashanth GP, Singh A, Kumar M. High frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation in preterm neonates with hyaline membrane disease: A randomized controlled trial. Indian Pediatr. 2012;49:405-8.

2. Cools F, Henderson-Smart DJ, Offringa M, Askie LM. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev. 2009 DOI: 10.1002/14651858.CD000104.pub 3

3. Cools F, Askie LM, Offringa M, Asselin JM, Calvert SA, Courtney SE, et al. Elective high-frequency oscillatory versus conventional ventilation in preterm infants: a systematic review and meta-analysis of individual patients’ data. Lancet. 2010;375:2082-91.

4. Prashanth GP, Malik GK, Singh SN. Elective high-frequency oscillatory ventilation in preterm neonates: A preliminary investigation in a developing country. Paediatr Int Child Health. 2012;32: 102-6.