Neonatal Unit, St. George's Hospital NHS Foundation Trust, London, UK.
St. George's University of London, London, UK.
Eur J Pediatr. 2022 May;181(5):2155-2159. doi: 10.1007/s00431-022-04411-0. Epub 2022 Feb 22.
During neurally adjusted ventilatory assist (NAVA)/non-invasive (NIV) NAVA, a modified nasogastric feeding tube with electrodes, monitors the electrical activity of the diaphragm (Edi). The Edi waveform determines the delivered pressure from the ventilator. Infant breathing is in synchrony with the ventilator and therefore is more comfortable with less work of breathing. Our aim was to determine if infants on NAVA had improved nutritional outcomes compared to infants managed on conventional respiratory support. A retrospective study was undertaken. Infants on NAVA were matched with two conventionally ventilated controls by gestational age, birth weight, sex, antenatal steroid exposure, and whether inborn or transferred ex utero. NAVA/NIV-NAVA was delivered by the SERVO-n® Maquet Getinge group ventilator. Conventional ventilation included pressure and volume control ventilation, and non-invasive ventilation included nasal intermittent positive pressure ventilation, triggered biphasic positive airway pressure, continuous positive airway pressure and heated humidified high flow oxygen. The measured outcome was discharge weight z scores. Eighteen "NAVA" infants with median gestational age (GA) of 25.3 (23.6-27.1) weeks and birth weight (BW) of 765 (580-1060) grams were compared with 36 controls with GA 25.2 (23.4-28) weeks (p = 0.727) and BW 743 (560-1050) grams (p = 0.727). There was no significant difference in the rates of postnatal steroids (61% versus 36% p = 0.093), necrotising enterocolitis (22% versus 11% p = 0.279) in the NAVA/NIV NAVA compared to the control group. There were slightly more infants who were breastfed at discharge in the NAVA/NIV NAVA group compared to controls: breast feeds (77.8% versus 58.3%), formula feeds (11.1% versus 30.6%), and mixed feeds (11.1% versus 11.1%), but this difference was not significant (p = 0.275). There was no significant difference in the birth z scores 0.235 (-1.56 to 1.71) versus -0.05 (-1.51 to -1.02) (p = 0.248) between the groups. However, the discharge z score was significantly in favour of the NAVA/NIV-NAVA group: -1.22 (-2.66 to -0.12) versus -2.17 (-3.79 to -0.24) in the control group (p = 0.033).Conclusion: The combination of NAVA/NIV-NAVA compared to conventional invasive and non-invasive modes may contribute to improved nutritional outcomes in premature infants.
在神经调节辅助通气（NAVA）/无创（NIV）NAVA 期间，带有电极的改良鼻胃管监测膈肌的电活动（Edi）。Edi 波形决定了呼吸机提供的压力。婴儿的呼吸与呼吸机同步，因此呼吸更舒适，呼吸功更小。我们的目的是确定与接受传统呼吸支持的婴儿相比，接受 NAVA 的婴儿是否有更好的营养结局。进行了一项回顾性研究。通过胎龄、出生体重、性别、产前类固醇暴露以及是否为宫内或宫外转移，将接受 NAVA 的婴儿与 2 名接受常规通气的对照婴儿进行匹配。NAVA/NIV-NAVA 由 SERVO-n® Maquet Getinge 组呼吸机提供。常规通气包括压力和容量控制通气，无创通气包括鼻内间歇正压通气、触发双相气道正压通气、持续气道正压通气和加热湿化高流量氧疗。测量的结果是出院体重 z 评分。与 36 名对照组相比，中位胎龄（GA）为 25.3（23.6-27.1）周和出生体重（BW）为 765（580-1060）克的 18 名“NAVA”婴儿（GA 为 25.2（23.4-28）周，p=0.727）和 BW 743（560-1050）克（p=0.727）。与对照组相比，NAVA/NIV-NAVA 组中接受产后类固醇的比例（61%与 36%，p=0.093）和坏死性小肠结肠炎（22%与 11%，p=0.279）的比例无显著差异。与对照组相比，NAVA/NIV-NAVA 组中有更多婴儿在出院时接受母乳喂养：母乳喂养（77.8%与 58.3%）、配方奶喂养（11.1%与 30.6%）和混合喂养（11.1%与 11.1%），但差异无统计学意义（p=0.275）。两组间出生时 z 评分无显著差异（0.235（-1.56 至 1.71）与-0.05（-1.51 至-1.02），p=0.248）。然而，NAVA/NIV-NAVA 组的出院时 z 评分明显优于对照组：-1.22（-2.66 至-0.12）与-2.17（-3.79 至-0.24），p=0.033）。结论：与传统的有创和无创通气模式相比，NAVA/NIV-NAVA 的联合应用可能有助于改善早产儿的营养结局。
