OBJECTIVES: High-frequency oscillatory ventilation with volume guarantee (HFOV with VG) can optimize respiratory support in preterm infants. However, its superiority over conventional HFOV remains uncertain. This systematic review aimed to analyze ventilatory and clinical effects of HFOV with VG compared with conventional HFOV in neonates under 44 weeks corrected gestational age. METHODS: We systematically searched Pubmed, EMBASE, Cochrane, and ClinicalTrials.gov from inception until August 4th, 2023, to identify randomized or observational studies comparing HFOV with VG with HFOV without VG in in neonates under 44 weeks corrected gestational age. Outcomes of interest included high-frequency tidal volume (VThf) and amplitude oscillations, carbon dioxide diffusion coefficient (DCO2) and carbon dioxide partial pressure (PaCO2) mean values, and episodes of hypocarbia or hypercarbia, hypoxemia episodes, duration of mechanical ventilation, rates of bronchopulmonary dysplasia and intraventricular hemorrhage, and death. ROB-2 and ROBINS were used for risk of bias assessment. RESULTS: This study included 260 patients from two crossover and four cohort studies. Gestational age at birth ranged from 23 to 29 weeks. The included studies presented a considerable risk of bias. A meta-analysis could not be performed, due to the differences in studies’ design, relevant risk of bias, incomplete reporting, and differences in ventilatory settings and reference values adopted. Report of the findings suggest that HFOV with VG, compared with HFOV, may reduce VThf variability and, consequently, hypo- and hypercarbia episodes. However, no significant differences in terms of BPD, IVH or mortality were observed. CONCLUSION: This systematic review does not provide evidence of the superiority of HFOV with VG over conventional HFOV in the context of ventilation of preterm infants, indicating the need for further studies evaluating the effects of VG on HFOV.

Purpose: Predicting Bronchopulmonary dysplasia (BPD) to assess the risk-benefit of the therapy is necessary due to the side effects of medications. We developed and validated an instrument for predicting BDP and compared it with an instrument currently used in neonates born in a Brazilian hospital. Methods: Retrospective cohort of patients born between 2016 and 2020, with gestational ages (GA) between 23 and 30 weeks. Predictive equations were elaborated using methods of selection of component variables: stepwise, conditional inference tree, Fisher’s exact test and all the collected variables; 70% of the sample was randomly selected for the construction of risk prediction equations, and the remaining 30% were used for their validation, application and comparison with the National Institute of Child Health and Human Development (NICHD) instrument published in 2011, currently used in that institution. Sensitivity, specificity, and predictive values of the equations were calculated. Results: The equation that used variables whose p-value was lower than 5% in Fisher’s exact test (clinical chorioamnionitis, GA, birth weight, sex, need for surfactant, patent ductus arteriosus, late-onset sepsis, inspired fraction of oxygen, and respiratory support) presented the best results: specificity of 98% and positive predictive value of 93%. Our instrument allowed applying the prediction to small-for-gestational-age (SGA). The currently used calculator applied to our population had a specificity of 93% and a positive predictive value of 75% and could not be applied to SGA patients. Conclusion: Our tool has a higher specificity and positive predictive value than the foreign instrument and is suited for SGA.