Preliminary Experience with Non-Invasive Neurally Adjusted Ventilatory Assist (NIV-NAVA) in Very Low Birth Weight Infants
Background: Neurally adjusted ventilatory assist (NAVA) improves synchronization between patient and ventilator and reduces the need for pressure and oxygen. We aimed to report our preliminary experience using non invasive NAVA (NIV-NAVA) in very low birth weight (VLBW) infants, and to compare its feasibility and efficiency to current standard methods of non synchronized non-invasive support (NS-NIVS) in terms of survival and survival without bronchopulmonary dysplasia (BPD).
Methods: Fifty-six VLBW infants with respiratory distress syndrome were included. After stabilization in delivery room, invasive or NIVS was initiated as deemed necessary by the clinician on duty. Patients receiving NIVS at admission or after extubation received support with the SERVO-n (Maquet) ventilator in the NIV-NAVA mode or with the Infant Flow (CareFusion) device in CPAP or Biphasic modes. We compared Survival and Survival without BPD between the two groups of patients.
Results: We compared 22 patients who received NIV-NAVA at some time by clinical criteria with 34 patients that never received it. No patient initially receiving NIV-NAVA needed reintubation or rescue to NS-NIVS. Patients that received NIV-NAVA were significantly more immature: 26.9 (2.0) vs. 28.9 (2.0) weeks GA, p<0.001), and had been intubated more frequently in delivery room: 50% vs. 11.8%, p=0.002. There were no differences in survival (95.5% vs. 100%, p=0.210), but patients in the NIV-NAVA group had a lower survival without BPD (59.1% vs. 97.1%, p<0.001).
Conclusion: In our setting, NIV-NAVA was used in patients more immature or as "rescue" of NS-NIVS successfully preventing re-intubations. No adverse effects attributable to the technique were observed.