University of New South Wales, Sydney, NSW, 2032, Australia.
Westmead Hospital, Westmead, NSW, 2145, Australia.
BMC Pediatr. 2024 Aug 9;24(1):514. doi: 10.1186/s12887-024-04981-y.
Preterm infants often require non-invasive breathing support while their lungs and control of respiration are still developing. Non-invasive neurally adjusted ventilatory assist (NIV-NAVA) is an emerging technology that allows infants to breathe spontaneously while receiving support breaths proportional to their effort. This study describes the first Australian Neonatal Intensive Care Unit (NICU) experience of NIV-NAVA.
Retrospective cohort study of infants admitted to a major tertiary NICU between October 2017 and April 2021 supported with NIV-NAVA. Infants were divided into three groups based on the indication to initiate NIV-NAVA (post-extubation; apnoea; escalation). Successful application of NIV-NAVA was based on the need for re-intubation within 48 h of application.
There were 169 NIV-NAVA episodes in 122 infants (82 post-extubation; 21 apnoea; 66 escalation). The median (range) gestational age at birth was 25 + 5 weeks (23 + 1 to 43 + 3 weeks) and median (range) birthweight was 963 g (365-4320 g). At NIV-NAVA application, mean (SD) age was 17 days (18.2), and median (range) weight was 850 g (501-4310 g). Infants did not require intubation within 48 h in 145/169 (85.2%) episodes [72/82 (87.8%) extubation; 21/21 (100%) apnoea; 52/66 (78.8%) escalation).
NIV-NAVA was successfully integrated for the three main indications (escalation; post-extubation; apnoea). Prospective clinical trials are still required to establish its effectiveness versus other modes of non-invasive support.
早产儿的肺部和呼吸控制仍在发育中，因此经常需要无创呼吸支持。神经调节辅助通气（NIV-NAVA）是一种新兴技术，可使婴儿在接受与努力成比例的支持呼吸的同时自主呼吸。本研究描述了澳大利亚第一个新生儿重症监护病房（NICU）使用 NIV-NAVA 的经验。
回顾性队列研究纳入 2017 年 10 月至 2021 年 4 月期间在主要三级 NICU 接受 NIV-NAVA 支持的婴儿。根据启动 NIV-NAVA 的指征（拔管后、呼吸暂停、升级）将婴儿分为三组。NIV-NAVA 的成功应用基于应用后 48 小时内重新插管的需要。
122 例婴儿中有 169 例（82 例拔管后、21 例呼吸暂停、66 例升级）出现 169 次 NIV-NAVA 事件。出生时的中位（范围）胎龄为 25+5 周（23+1 至 43+3 周），中位（范围）出生体重为 963g（365-4320g）。NIV-NAVA 应用时，平均（标准差）年龄为 17 天（18.2），中位数（范围）体重为 850g（501-4310g）。169 次事件中有 145 次（85.2%）在 48 小时内无需插管[72/82（87.8%）拔管；21/21（100%）呼吸暂停；52/66（78.8%）升级]。
NIV-NAVA 成功应用于三种主要指征（升级、拔管后、呼吸暂停）。仍需要前瞻性临床试验来确定其与其他非侵入性支持模式相比的有效性。
