Introduction The present article reports our experience with high-frequency oscillatory ventilation (HFOV) in newborns with acute respiratory failure (ARF), who deteriorated on conventional mechanical ventilation.

Methods The chart records of 47 consecutively HFOV-treated newborns from 1 January 2005 to January 2008 were retrospectively analyzed. The parameters of demographic data, cause of respiratory insufficiency, Pediatric Index of Mortality score, oxygenation index and PaCO₂ were recorded and calculated at various time points before and after the start of HFOV, along with patient outcome and cause of death.

Results The overall survival rate was 58%. The oxygenation index was significantly higher before and during HFOV in newborns with acute respiratory failure than in newborns with conventional mechanical ventilation. The PaCO₂ prior to HFOV was higher in conventional mechanical ventilation patients compared with newborns with acute respiratory failure after the initiation of HFOV.

Conclusion HFOV rescue therapy was associated with a high survival percentage in a selected group of newborns. Patients with HFOV rescue therapy primarily had oxygenation failure. Future studies are necessary to evaluate whether the outcome in this group of patients may be improved if HFOV is applied earlier in the course of disease. Patients with conventional mechanical ventilation primarily had severe hypercapnia and HFOV therapy was very effective in achieving adequate ventilation.