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

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
,
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
,
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
› Institutsangaben
Funding None.

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.

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.




Publikationsverlauf

Eingereicht: 25. Juni 2021

Angenommen: 16. August 2021

Artikel online veröffentlicht:
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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  • References

  • 1 Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ 2012; 345: e7976
  • 2 Shetty S, Greenough A. Neonatal ventilation strategies and long-term respiratory outcomes. Early Hum Dev 2014; 90 (11) 735-739
  • 3 Stein H, Firestone K. Application of neurally adjusted ventilatory assist in neonates. Semin Fetal Neonatal Med 2014; 19 (01) 60-69
  • 4 Beck J, Reilly M, Grasselli G. et al. Patient-ventilator interaction during neurally adjusted ventilatory assist in low birth weight infants. Pediatr Res 2009; 65 (06) 663-668
  • 5 Firestone KS, Beck J, Stein H. Neurally adjusted ventilatory assist for noninvasive support in neonates. Clin Perinatol 2016; 43 (04) 707-724
  • 6 Stein H, Beck J, Dunn M. Non-invasive ventilation with neurally adjusted ventilatory assist in newborns. Semin Fetal Neonatal Med 2016; 21 (03) 154-161
  • 7 Shetty S, Evans K, Kulkarni A, Greenough A. Impact of a care bundle on cost saving for noninvasive respiratory support for neonates. Adv Neonatal Care 2021; (e-pub ahead of print) DOI: 10.1097/ANC.0000000000000856.
  • 8 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
  • 9 Sant'Anna GM, Keszler M. Weaning infants from mechanical ventilation. Clin Perinatol 2012; 39 (03) 543-562
  • 10 Hermeto F, Martins BM, Ramos JR, Bhering CA, Sant'Anna GM. Incidence and main risk factors associated with extubation failure in newborns with birth weight < 1,250 grams. J Pediatr (Rio J) 2009; 85 (05) 397-402
  • 11 Giaccone A, Jensen E, Davis P, Schmidt B. Definitions of extubation success in very premature infants: a systematic review. Arch Dis Child Fetal Neonatal Ed 2014; 99 (02) F124-F127
  • 12 Makker K, Cortez J, Jha K. et al. Comparison of extubation success using noninvasive positive pressure ventilation (NIPPV) versus noninvasive neurally adjusted ventilatory assist (NI-NAVA). J Perinatol 2020; 40 (08) 1202-1210
  • 13 Rong X, Liang F, Li YJ. et al. Application of neurally adjusted ventilatory assist in premature neonates less than 1,500 grams with established or evolving bronchopulmonary dysplasia. Front Pediatr 2020; 8: 110