Neurally adjusted ventilatory assist for rapid weaning in preterm infants

Background: Neurally adjusted ventilatory assist (NAVA) is a new mode of subject-triggered ventilation. Experience with the use of NAVA in preterm infants is limited. This study compared the effects of invasive mechanical ventilation with NAVA to conventional intermittent mandatory ventilation (CIMV) in terms of reducing the duration of oxygen requirement and invasive ventilator support in preterm infants. Methods: This was a prospective study. We enrolled infants of less than 32 weeks’ gestation who were then randomized to receive either NAVA or CIMV support during hospitalization. We recorded and analyzed data on the maternal history during pregnancy, use of medications, neonatal data at admission, neonatal diseases, and respiratory support in the neonatal intensive care unit. Results: There were 26 preterm infants in the NAVA group and 27 preterm infants in the CIMV group. Significantly fewer infants in the NAVA group received supplemental oxygen at 28 days of age (12 [46%] vs. 21 [78%], p = 0.0365), and they required significantly fewer days of invasive ventilator support: 7.73 (± 2.39) vs. 17.26 (± 3.65), p = 0.0343. Conclusions: Compared with CIMV, NAVA appears to allow for more rapid weaning from invasive ventilation and decreases the incidence of bronchopulmonary dysplasia, especially in preterm infants with severe respiratory distress syndrome treated with surfactants.