NIV NAVA versus Nasal CPAP in Premature Infants: A Randomized Clinical Trial

Abstract

<b><i>Background:</i></b> Noninvasive ventilation is recommended for neonatal respiratory distress to avoid adverse effects of invasive ventilation. <b><i>Objective:</i></b> The aim of this study was to compare the feasibility of noninvasive neurally adjusted ventilatory assist (NIV NAVA) and continuous positive airway pressure (CPAP) in preterm newborn infants. <b><i>Methods:</i></b> Forty preterm infants (gestational age 28+0 to 36+6 weeks) requiring CPAP and supplemental oxygen (FiO<sub>2</sub> >0.23) for respiratory distress at <48 h of postnatal age were randomized to NIV NAVA or CPAP. The primary endpoint was the inspired oxygen concentration 12 h after study inclusion. Secondary endpoints were the duration of oxygen treatment, total duration of respiratory support, parenteral nutrition, blood gas values, patient comfort, need for invasive ventilation, and treatment complications. <b><i>Results:</i></b> The mean FiO<sub>2</sub> at the time of study inclusion was 0.29 in both groups. After 12 h of treatment, FiO<sub>2</sub> was 0.26 ± 0.07 and 0.26 ± 0.04 in the NIV NAVA and CPAP groups, respectively (difference 0.006, 95% CI –0.4 to 0.5), with no difference between the groups during the course of noninvasive ventilation (<i>p</i> = 0.80). Seven patients (35%) in the NIV NAVA group and 10 (50%) in the control group required intubation (difference 15%, 95% CI –15.5 to 4.3, <i>p</i> = 0.36). Time to intubation, gas exchange, vital parameters, pain scale, treatment complications, and neonatal outcome did not differ between the groups. <b><i>Conclusions:</i></b> In the present trial, NIV NAVA had no statistically significant effect on oxygen requirements or the need for invasive ventilation in preterm newborn infants.

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

“…The apnea detection time used to trigger back‐up ventilation was 10 s and a shorter period may have been more appropriate in these patients 36 . Although some small randomized controlled trials 9,37 and retrospective studies 38–40 reported reduced respiratory failure rates with NIV‐NAVA, there is a lack of good evidence to determine its superiority over other modes of noninvasive support 41 . Thus, until larger randomized trials are conducted, some caution should be exercised when integrating NIV‐NAVA into the care of extremely preterm infants.…”

Non-Invasive Ventilatory Strategies to Decrease Bronchopulmonary Dysplasia—Where Are We in 2021?

“…Yagui et al conducted a RCT (n = 123) comparing NIV-NAVA vs. NCPAP as the primary support in infants with BW <1500 g. There was no difference noted in the primary outcome of need for intubation prior to 72 hours of life, or for the secondary outcome of BPD, between the two groups [82]. Other small RCTs have shown that NIV-NAVA is as effective as NCPAP in preventing extubation failure, but large RCTs studying the outcome of BPD in extremely preterm infants are needed before NIV-NAVA can be routinely recommended [83][84][85][86][87].…”

Proportional assist and neurally adjusted ventilation: Clinical knowledge and future trials in newborn infants

“…Two recent randomized controlled studies comparing NIV‐NAVA with nasal CPAP during the early stages of RDS in moderately preterm infants, did not show any benefit in avoiding and/or time to intubation 57,58 (Table 4). Even though no difference was observed between NIV‐NAVA and nCPAP with respect to need of intubation in both these studies (35 vs. 50%, Kallio et al; 20.3 vs. 15.6%, Yagui et al), a longer duration of mechanical ventilation in the NIV‐NAVA group was reported in the study by Kallio et al, whereas a shorter duration could be observed by Yagui et al, possibly explained by surfactant being administered non‐invasively and earlier in the latter study but contradicted by the fact that NIV‐NAVA combined with early surfactant did not result in later intubation compared to nasal CPAP with early surfactant in that study 57,58 (Table 4). Using NIV‐NAVA after extubation seems more promising where two small retrospective studies observed more successful weaning with NIV‐NAVA than nCPAP, measured as failure within 72 h of extubation 59,60 .…”