Effect of electrical activity of the diaphragm waveform patterns on SpO₂ for extremely preterm infants ventilated with neurally adjusted ventilatory assist

Abstract

Objective: This study aimed to evaluate the association between electrical activity of the diaphragm (Edi) waveform patterns and peripheral oxygen saturation (SpO 2 ) in extremely preterm infants who are ventilated with neurally adjusted ventilatory assist (NAVA). Study Design:We conducted a retrospective cohort study at a level III neonatal intensive care unit. Extremely preterm infants born at our hospital between November 2019 and November 2020 and ventilated with NAVA were included. We collected Edi waveform data and classified them into four Edi waveform patterns, including the phasic pattern, central apnea pattern, irregular low-voltage pattern, and tonic burst pattern. We analyzed the Edi waveform pattern for the first 15 h of collectable data in each patient. To investigate the association between Edi waveform patterns and SpO 2 , we analyzed the dataset every 5 min as one data unit. We compared the proportion of each waveform pattern between the desaturation (Desat [+]) and non-desaturation (Desat [-]) groups.Results: We analyzed collected data for 105 h (1260 data units). The proportion of the phasic pattern in the Desat (+) group was significantly lower than that in the Desat (-) group (p < .001). However, the proportions of the central apnea, irregular low-voltage, and tonic burst patterns in the Desat (+) group were significantly higher than those in the Desat (-) group (all p < .05). Conclusion:Our results indicate that proportions of Edi waveform patterns have an effect on desaturation of SpO 2 in extremely preterm infants who are ventilated with NAVA.

Effect of doxapram on the electrical activity of the diaphragm waveform pattern of preterm infants

“…This pattern was increased after doxapram administration. Conversely, unstable SpO 2 was represented by a high frequency of the central apnea pattern or irregular low‐voltage pattern, which may ultimately result in failure to ventilate with NAVA 11 . These patterns were decreased after doxapram administration in the present study.…”

“…As described in a previous report, the collected data of Edi waveform patterns were classified into four patterns as follows: (1) phasic pattern, (2) central apnea pattern, (3) irregular low‐voltage pattern, and (4) tonic burst pattern 11 (as shown in Figure 1). Edi waveforms were indicated in 1 window every 10 s. The classification of Edi waveform patterns shown in each window was performed by one investigator (clinical data not informed).…”

“…The ventilator settings of NAVA were adjusted according to the methods described in our previous study. 11 When the infants demonstrated any instability in their respiratory function despite being supported with precisely adjusted ventilator settings of NAVA, we resorted to administering doxapram. In addition, we administered doxapram a few days before extubation to prevent reintubation due to the patients' poor spontaneous breathing.…”

“…Previously, we reported that the electrical activity of the diaphragm (Edi) waveform pattern was associated with peripheral oxygen saturation (SpO 2 ) of the infants ventilated with NAVA 11 . In that report, we did not consider the effect of any medications, such as caffeine citrate or doxapram.…”

Skin-to-Skin Contact and Diaphragm Electrical Activity in Preterm Infants During Noninvasive Pressure Control

“…9 Recently, the assessment of respiratory patterns in neonates and preterm infants has benefited from the use of the electrical activity of the diaphragm (Edi). 10,11 Edi serves as an indicator of diaphragmatic electromyography and can be measured using an Edi catheter, a specialized nasogastric tube equipped ABSTRACT Background: Skin-to-skin contact (SSC) is widely implemented in the neonatal intensive care unit (NICU) due to its established role in reducing mortality and morbidity. However, the impact of SSC on diaphragmatic electrical activity (Edi) in premature infants undergoing noninvasive pressure control (NIV-PC) for respiratory management remains insufficiently explored.…”