Neurally adjusted ventilatory assist (NAVA) in very preterm infants: A single tertiary neonatal unit’s experience

Abstract

Background: During NAVA/ NIV (non-invasive) NAVA, a modified nasogastric feeding tube with electrodes monitors the electrical activity of the diaphragm (Edi). This Edi waveform determines the delivered pressure from the ventilator. Our aim was to determine whether, in preterm infants with evolving/ established BPD NAVA/ NIV-NAVA had advantages over conventional modes of respiratory support.

Methods: A retrospective study was undertaken. Infants on NAVA were matched with two conventionally ventilated controls by gestational age, birth weight, sex, antenatal steroid exposure and whether inborn/or transferred ex utero. NAVA/ NIV-NAVA was delivered by the SERVO-n® Maquet Getinge group ventilator and conventional ventilation by the Stephanie STEPHAN ventilator: biphasic positive airway pressure, continuous positive airway pressure and heated humidified high flow oxygen were the non-invasive modes.

Results: Infants on NAVA/ NIV NAVA had lower rates of extubation failure (median 0 (0-5) versus 1 (0-6) p=0.048), shorter duration of invasive ventilation (median 30.5 (1-90) days versus 40.5 (11-199) days p=0.046), shorter total duration of invasive and NIV up to discharge from the local hospital (median 80 (57-140) days versus 103.5 (60-246) days p=0.026). In addition, the total length of stay in hospital was lower in NAVA/ NIV-NAVA group (111.5 (78-183) days versus 140 (82-266) days p=0.019). There were no statistically significant differences in BPD rates between the groups, 11/18 (61%) versus 30/36 (83%) (p=0.072).

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