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CC BY-NC-ND 4.0 · AJP Rep 2021; 11(04): e127-e131
DOI: 10.1055/s-0041-1739458
Original Article

Neurally Adjusted Ventilatory Assist in Very Prematurely Born Infants with Evolving/Established Bronchopulmonary Dysplasia

Sandeep Shetty 
1   Neonatal Intensive Care Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
2   Department of Neonatal Medicine, St George's University of London, London, United Kingdom
,
Katie Evans
1   Neonatal Intensive Care Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
,
Peter Cornuaud
1   Neonatal Intensive Care Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
,
Anay Kulkarni 
1   Neonatal Intensive Care Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
,
Donovan Duffy
1   Neonatal Intensive Care Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
2   Department of Neonatal Medicine, St George's University of London, London, United Kingdom
,
Anne Greenough 
3   Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom
4   The Asthma UK Centre in Allergic Mechanisms of Asthma, Kings College London, London, United Kingdom
5   NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, United Kingdom
› Author Affiliations Funding None.
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Abstract

Background During neurally adjusted ventilatory assist (NAVA)/noninvasive (NIV) NAVA, a modified nasogastric feeding tube with electrodes monitors the electrical activity of the diaphragm (Edi). The Edi waveform determines the delivered pressure from the ventilator.

Objective Our objective was to determine whether NAVA/NIV-NAVA has advantages in infants with evolving/established bronchopulmonary dysplasia (BPD).

Methods Each infant who received NAVA/NIV-NAVA and conventional invasive and NIV was matched with two historical controls. Eighteen NAVA/NIV-NAVA infants’ median gestational age, 25.3 (23.6–28.1) weeks, was compared with 36 historical controls’ median gestational age 25.2 (23.1–29.1) weeks.

Results Infants on NAVA/NIV-NAVA had lower extubation failure rates (median: 0 [0–2] vs. 1 [0–6] p = 0.002), shorter durations of invasive ventilation (median: 30.5, [1–90] vs. 40.5 [11–199] days, p = 0.046), and total duration of invasive and NIV to the point of discharge to the local hospital (median: 80 [57–140] vs. 103.5 [60–246] days, p = 0.026). The overall length of stay (LOS) was lower in NAVA/NIVNAVA group (111.5 [78–183] vs. 140 [82–266] days, p = 0.019). There were no significant differences in BPD (17/18 [94%] vs. 32/36 [89%] p = 0.511) or home oxygen rates (14/18 [78%] vs. 23/36 [64%] p = 0.305).

Conclusion The combination of NAVA/NIV-NAVA compared with conventional invasive and NIV modes may be advantageous for preterm infants with evolving/established BPD.

Keywords

neurally adjusted ventilatory assist - prematurity - neonatal trigger ventilation - length of hospital stay - ventilation days

Availability of Data and Materials

Data given in tables and as text in manuscript.


Authors' Contributions

S.S. and A.G. designed the study; S.S., K.E., and D.D. collected the data. P.C., S.S., and A.K. designed the statistical analysis and analyzed the data. All authors were involved in the preparation of the manuscript and approved the final manuscript as submitted.




Publication History

Received: 25 June 2021

Accepted: 16 August 2021

Article published online:
22 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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