Objective To explore the clinical efficacy of high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal pulmonary hemorrhage (NPH). Methods A total of 122 neonates diagnosed with NPH between January 2010 and June 2014 were enrolled. After being stratified by gestational age, the neonates were randomly divided into treatment (HFOV+PS) and control (HFOV alone) groups (n=61 each). Both groups were treated with HFOV after the onset of NPH. After 2-4 hours of HFOV treatment, the treatment group received PS via intratracheal injections, followed by continuous use of HFOV. Dynamic changes in the blood gas, oxygenation index (OI), and PaO₂/FiO₂ (P/F) values of the neonates were determined before HFOV treatment and after 6, 12, and 24 hours of HFOV treatment. The time to hemostasis, duration of ventilation, incidence of complications, and cure rate were compared between groups. Results After 6, 12, and 24 hours of HFOV treatment, the treatment group had significantly improved PaO₂, PaCO₂, O/I, and P/F values compared with the control group (P<0.05). The time to hemostasis and the duration of ventilation were significantly shorter in the treatment group than in the control group (P<0.01), and the incidence of complications was lower in the former than in the latter (P<0.05). There was no significant difference in the cure rate between the treatment (87%) and control (82%) groups (P>0.05). Conclusions HFOV combined with PS is an effective treatment to improve oxygenation, shorten the time to hemostasis and the duration of ventilation, and reduce the incidence of complications in neonates with NPH. However, the dual therapy is unable to reduce the mortality of neonates compared with HFOV monotherapy.