To investigate efficacy of high frequency oscillatory ventilation (HFOV)+ volume guarantee (VG) ventilation in the treatment of persistent pulmonary hypertension (PPHN) in neonates.

From March 2016 to September 2019, a total of 93 neonates with PPHN admitted to Wuhan Children′s Hospital, Tongji Medical College of Huazhong University of Science & Technology and Tongji Hospital, Tongji Medical College of Huazhong University of Science & Technology were selected into this study. They were divided into three groups according to random number table, HFOV+ VG group (n=30, treatment by HFOV combined with VG); HFOV group (n=31, treatment by single HFOV) and SIMV+ VG group (n=32, treatment by SIMV combined with VG). Oxygenation index (OI), arterial/alveolar oxygen partial pressure ratio (a/APO₂), duration of oxygen therapy, duration of mechanical ventilation (MV), duration of NO inhalation(iNO), hospital stay, recent complications and neurological follow-up were observed. Gestational age, systolic pulmonary arterial pressure (sPAP), birth weight, Apgar score at 5 minutes after birth, duration of mechanical ventilation, duration of oxygen therapy, duration of iNO, hospital stay, and hospital costs among three groups were analyzed by one-way ANOVA and least significant difference (LSD)-t test for overall comparison and further comparison between each two groups. OI and a/APO₂ at different time points among three groups were statistically analyzed by ANOVA of repeated measurement data, independent-samples t test and LSD-t test. Gender, etiological constituent ratio and incidence of complications were analyzed by chi-square test.The procedures followed in this study were in accordance with the standards established by the Committee of Investigation in Human Beings of Wuhan Children′s Hospital, Tongji Medical College of Huazhong University of Science & Technology, and this study was approved by the committee (Approval No. 2016045). Informed consent was obtained from each participates′ guardians.

①There were no significant differences among three groups in clinical data, such as gender, gestational age, sPAP, birth weight, Apgar score at 5 minutes after birth and OI (P>0.05). ②The OI and a/APO₂ at 0, 12, 24 and 72 h after MV among 3 groups showed that, for OI, there was an interaction effect between different treatment measures and time factors (F_{treatment×time}=9.420, P<0.001); for a/APO₂, there was interaction effect between different treatment measures and time factors (F_{treatment×time}=21.331, P<0.001). ③There were significant differences in the duration of mechanical ventilation, oxygen therapy, iNO, hospital stay and hospitalization costs among 3 groups (P<0.05). ④There was no significant difference in the incidence of VAP, pulmonary air leak, pulmonary hemorrhage, intracranial hemorrhage, 28 d mortality and survival time among 3 groups (P>0.05). ⑤The results of the five performance areas of the Gesell Developmental Scale at 3 and 6 months of age in the three groups showed that there were no significant differences in the developmental quotient of macromotor behavior, fine motor behavior, language behavior, adaptive behavior, and personal social behavior (P>0.05). ⑤The results of the 5 Gesell subscales of Gesell Developmental Scale at 3- and 6-month among 3 groups showed that there were no significant differences in the developmental quotient of gross motor behavior, fine motor behavior, language behavior, adaptive behavior and personal social behavior (P>0.05).

HFOV+ VG mode can rapidly improve the pulmonary oxygenation, shorten MV and iNO duration, reduce average length of hospital stay and hospitalization costs, does not affect the incidence of short-term complications and long-term neurological development outcomes.