Electrical Activity of the Diaphragm in a Small Cohort of Preterm Infants on Noninvasive Neurally Adjusted Ventilatory Assist and Continuous Positive Airway Pressure: A Prospective Comparative Pilot Study

Abstract

Objective: To compare the electrical activity of the diaphragm (Edi) of premature infants placed on continuous positive airway pressure (CPAP) with the Edi of premature infants placed on noninvasive neurally adjusted ventilatory assist (NIV NAVA). The secondary aim was to evaluate the feasibility of the use of NIV NAVA mode in the busy tertiary neonatal unit. Study Design: This was a prospective crossover pilot study of premature infants requiring noninvasive respiratory support. Infants were randomized to initially receive either CPAP/biphasic (group 1) or NIV NAVA (group 2) and were then crossed over to the alternate group. Continuous Edi signals were recorded for 24 h, with 12 h each on CPAP/biphasic, and NIV NAVA along with other clinical and respiratory parameters. Results: Ten infants with a mean gestation age of 29 weeks (range 25-34 weeks) were enrolled, with a total cumulative Edi monitoring of 240 h. The average Edi peak on the biphasic/CPAP group (15.6 ± 7 mcV) was significantly higher (P < 0.005), compared to the Edi Peak on the NIV NAVA group (10.8 ± 3.3 mcV). The Edi min values were 3.23 ± 1.1 mcV, and 3.07 ± 0.5 mcV on CPAP/biphasic and NIV NAVA (P = 0.69) respectively. There were no significant differences in other clinical parameters between the two groups. No major adverse events were recorded during Edi catheter monitoring. Conclusion: The Edi peak values were significantly lower in NIV NAVA mode compared to CPAP/biphasic mode. The Edi catheter and NIV NAVA may also be used safely in premature infants.

Cardiorespiratory effects of NIV‐NAVA, NIPPV, and NCPAP shortly after extubation in extremely preterm infants: A randomized crossover trial

“…In that respect, infants seemingly adapt and reduce their respiratory efforts during NIV‐NAVA. Indeed, a similar decrease has been demonstrated in preterm infants during other crossover studies comparing NCPAP, biphasic positive airway pressure, or NIPPV with NIV‐NAVA 13,26,27 …”

Cardiorespiratory effects of NIV-NAVA, NIPPV, and NCPAP shortly after extubation in extremely preterm infants: a randomized crossover trial

“…In that respect, infants seemingly adapt and reduce their respiratory efforts during NIV-NAVA. Indeed, a similar decrease has been demonstrated in preterm infants during other crossover studies comparing NCPAP, biphasic positive airway pressure or NIPPV with NIV-NAVA 12,25,26 .…”

Resultados de la ventilación asistida ajustada neuronalmente no invasiva y la presión positiva continua nasal en recién nacidos prematuros: revisión sistemática y metanálisis

“…Después de analizar el texto completo de los artículos restantes, se incluyeron en el estudio tres artículos en total (Figura 1). [10][11][12] Los estudios habían sido publicados en 2019 y representaban una amplia distribución de países. Las características de los estudios incluidos en el metanálisis se describen en la Tabla 1, y las características de los pacientes, en la Tabla 2.…”

“…Yagui y col. 10 Gupta y col. 11 Kallio y col. 12 Oxigenación FiO 2 ≥ 0,40 con PPC de cumplieron los requisitos incluían 173 pacientes (89 pacientes que recibieron NAVA-NIV y 84, NCPAP). Un estudio 11 era un ensayo de grupos cruzados en el cual los pacientes estuvieron en un modo seleccionado durante un período antes de cambiar a un modo alternativo; este estudio usó la NAVA-NIV como técnica de desconexión de los recién nacidos prematuros, mientras que otros estudios usaron la NAVA-NIV antes de aplicar la ventilación mecánica.…”