Faculty Opinions recommendation of Non-invasive neurally adjusted ventilatory assist in preterm infants: a randomised phase II crossover trial.

Abstract We aimed to examine the effect of changing levels of support (NAVA level) during non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in preterm infants with respiratory distress syndrome (RDS) on electrical diaphragm activity. This is a prospective, single-centre, interventional, exploratory study in a convenience sample. Clinically stable preterm infants supported with NIV-NAVA for RDS were eligible. Patients were recruited in the first 24 hours after the start of NIV-NAVA. Following a predefined titration protocol, NAVA levels were progressively increased starting from a level of 0,5 cmH2O/µV and with increments of 0,5 cmH2O/µV every 3 minutes, up to a maximum level of 4,0 cmH2O/µV. We measured the evolution of peak inspiratory pressure (PIP) and the electrical signal of the diaphragm (Edi) during NAVA level titration. Twelve infants with a mean (SD) gestational age at birth of 30,6 (3,5) weeks and birth weight of 1454 (667) g were enrolled. For all patients a breakpoint could be identified during the titration study. The breakpoint was on average (SD) at a level of 2,33 (0,58) cmH2O/µV. With increasing NAVA levels, the respiratory rate decreased significantly. No severe complications occurred.Conclusions: Preterm neonates with RDS supported with NIV-NAVA display a biphasic response to changing NAVA levels with an identifiable breakpoint. This breakpoint was at a higher NAVA level than commonly used in this clinical situation. Immature neural feedback mechanisms warrant careful monitoring of preterm infants when supported with NIV-NAVA.Clinical trial registration: clinicaltrials.gov NCT03780842. Date of registration December 12, 2018.

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The evaluation of the efficacy and safety of non-invasive neurally adjusted ventilatory assist in combination with INtubation-SURfactant-Extubation technique for infants at 28 to 33 weeks of gestation with respiratory distress syndrome

SAGE Open Medicine ◽

10.1177/2050312119838417 ◽

2019 ◽

Vol 7 ◽

pp. 205031211983841 ◽

Cited By ~ 1

Author(s):

Jun Miyahara ◽

Hiroshi Sugiura ◽

Shigeru Ohki

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Preterm Infants ◽

Distress Syndrome ◽

Periventricular Leukomalacia ◽

Extubation Failure ◽

Neurally Adjusted Ventilatory Assist ◽

Efficacy And Safety ◽

Non Invasive ◽

Ventilatory Assist

Objectives: The aim of this study is to evaluate the efficacy and safety of non-invasive neurally adjusted ventilatory assist used after INtubation-SURfactant-Extubation in preterm infants with respiratory distress syndrome. Methods: We conducted a prospective observational study that included 15 inborn preterm infants at 28 (0/7) to 33 (6/7) weeks of gestation with respiratory distress syndrome in the period from April 2017 to October 2018. After INtubation-SURfactant-Extubation, infants underwent non-invasive neurally adjusted ventilatory assist. INtubation-SURfactant-Extubation failure was defined as follows: fraction of inspired oxygen requirement >0.4, respiratory acidosis, and severe apnea within 5 days after surfactant administration. Results: Two of the 15 (13.3%) infants showed INtubation-SURfactant-Extubation failure and required mechanical ventilation. No infants experienced any major complications such as pneumothorax, patent ductus arteriosus ligation, severe intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, or death. Conclusion: The rate of INtubation-SURfactant-Extubation failure when non-invasive neurally adjusted ventilatory assist was used after INtubation-SURfactant-Extubation for preterm infants with respiratory distress syndrome was 13.3%. Non-invasive neurally adjusted ventilatory assist can be safely performed without severe complications for preterm infants soon after birth.

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Non-invasive neurally adjusted ventilatory assist versus nasal intermittent positive-pressure ventilation in preterm infants born before 30 weeks’ gestation

Pediatrics International ◽

10.1111/ped.13680 ◽

2018 ◽

Vol 60 (10) ◽

pp. 957-961 ◽

Cited By ~ 7

Author(s):

Kousuke Yonehara ◽

Ryo Ogawa ◽

Yoshiya Kamei ◽

Arata Oda ◽

Masayo Kokubo ◽

...

Keyword(s):

Preterm Infants ◽

Positive Pressure Ventilation ◽

Intermittent Positive Pressure Ventilation ◽

Positive Pressure ◽

Neurally Adjusted Ventilatory Assist ◽

Non Invasive ◽

Ventilatory Assist

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Effects of heliox and non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in preterm infants

Scientific Reports ◽

10.1038/s41598-021-95444-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Natalia Neumann-Klimasińska ◽

T. Allen Merritt ◽

Jennifer Beck ◽

Izabela Miechowicz ◽

Marta Szymankiewicz-Bręborowicz ◽

...

Keyword(s):

Preterm Infants ◽

Cerebral Oxygenation ◽

Peak Inspiratory Pressure ◽

Preterm Neonates ◽

Neurally Adjusted Ventilatory Assist ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Ventilatory Parameters ◽

Ventilatory Assist ◽

Ventilatory Failure

AbstractDue to its unique properties, helium–oxygen (heliox) mixtures may provide benefits during non-invasive ventilation, however, knowledge regarding the effects of such therapy in premature infants is limited. This is the first report of heliox non-invasive neurally adjusted ventilatory assist (NIV-NAVA) ventilation applied in neonates born ≤ 32 weeks gestational age. After baseline NIV-NAVA ventilation with a standard mixture of air and oxygen, heliox was introduced for 3 h, followed by 3 h of air-oxygen. Heart rate, peripheral capillary oxygen saturation, cerebral oxygenation, electrical activity of the diaphragm (Edi) and selected ventilatory parameters (e.g., respiratory rate, peak inspiratory pressure) were continuously monitored. We found that application of heliox NIV-NAVA in preterm infants was feasible and associated with a prompt and significant decrease of Edi suggesting reduced respiratory effort, while all other parameters were stable throughout the study, and had similar values during heliox and air-oxygen ventilation. This therapy may potentially enhance the efficacy of non-invasive respiratory support in preterm neonates and reduce the number of infants progressing to ventilatory failure.

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