Lee Yeongseok, Lee Juyoung
Department of Pediatrics, Inha University College of Medicine, Incheon, South Korea.
Department of Pediatrics, Korea University Anam Hospital, Seoul, South Korea.
Pediatr Int. 2024 Jan-Dec;66(1):e15831. doi: 10.1111/ped.15831.
Evidence to show that neurally adjusted ventilatory assist (NAVA) improves clinical outcomes is lacking. We aimed to analyze whether NAVA improves respiratory outcomes in preterm infants who require invasive mechanical ventilation.
A retrospective cohort study was conducted in 122 very low birthweight infants who required invasive mechanical ventilation for more than 24 h at one tertiary neonatal intensive care unit in Korea from January 2016 to June 2023. Subjects were divided into three groups: early NAVA for those supported with NAVA before the seventh day of life (n = 18), late NAVA for those supported with NAVA later than the seventh day (n = 18), and conventional for those supported with conventional ventilation modes other than NAVA (n = 86).
There was no difference in the composite outcome of bronchopulmonary dysplasia or death among the three groups. Neonates who had been supported with NAVA at some point had lower odds of mortality than those who had not (adjusted odds ratio [aOR] 0.09, 95% CI 0.01-0.90, p = 0.040 for the early NAVA group; aOR 0.15, 95% CI 0.03-0.81, p = 0.027 for the late NAVA group). The adjusted hazard ratio for invasive mechanical ventilation weaning was higher in neonates supported with NAVA within the first week of life than in those supported with other ventilation modes (aHR 2.02, 95% CI 1.14-3.57, p = 0.015).
Neurally adjusted ventilatory assist application was associated with lower odds of mortality, and its early application from the first few days of life helped preterm infants wean from invasive mechanical ventilation sooner.
缺乏证据表明神经调节通气辅助（NAVA）能改善临床结局。我们旨在分析NAVA是否能改善需要有创机械通气的早产儿的呼吸结局。
对2016年1月至2023年6月在韩国一家三级新生儿重症监护病房接受有创机械通气超过24小时的122例极低出生体重儿进行回顾性队列研究。将受试者分为三组：生命第7天前接受NAVA支持的早期NAVA组（n = 18）、生命第7天后接受NAVA支持的晚期NAVA组（n = 18）和接受除NAVA外的传统通气模式支持的传统组（n = 86）。
三组间支气管肺发育不良或死亡的复合结局无差异。曾在某个时间点接受NAVA支持的新生儿的死亡几率低于未接受支持的新生儿（早期NAVA组调整后的优势比[aOR]为0.09，95%置信区间[CI]为0.01 - 0.90，p = 0.040；晚期NAVA组aOR为0.15，95% CI为0.03 - 0.81，p = 0.027）。出生后第一周内接受NAVA支持的新生儿有创机械通气撤机的调整风险比高于接受其他通气模式支持的新生儿（调整后风险比[aHR]为2.02，95% CI为1.14 - 3.57，p = 0.015）。
神经调节通气辅助的应用与较低的死亡几率相关，且从出生后最初几天开始早期应用有助于早产儿更快地从有创机械通气中撤机。
