Neurally adjusted ventilatory assist in extremely low-birthweight infants

BackgroundNeurally adjusted ventilatory assist (NAVA) is expected to improve respiratory outcomes in preterm infants, but it has not yet been evaluated. We investigated whether NAVA could improve respiratory outcomes and reduce sedation use in extremely low-birthweight infants (ELBWI). MethodsA retrospective cohort study was conducted based on patient charts at the Nagano Children's Hospital neonatal intensive care unit, Japan. Infants who were born at <27 weeks' gestation were included. We assessed the prevalence of bronchopulmonary dysplasia (BPD), home oxygen therapy (HOT), duration of intubation, and sedation use. ResultsThe NAVA group consisted of 14 ELBWI who were born at <27 weeks' gestation between September 2013 and September 2015. A total of 21 ELBWI born between September 2011 and September 2013, before NAVA implementation, served as the control group. There were no significant differences in the perinatal background characteristics between the two groups. For respiratory outcomes, no significant between-group differences were found in the prevalence of BPD and HOT or the duration of intubation. The total duration of sedation use was not significantly different between the two groups, but in the NAVA group, midazolam was discontinued in all cases after the infants were switched to NAVA. ConclusionsNAVA was safe in preterm infants and had a similar effect to conventional mechanical ventilation with regard to respiratory outcomes and sedation use in the chronic phase; thus, NAVA could be used in the early phase, at least before BPD worsens to improve respiratory outcomes in ELBWI.