Effects of Neurally Adjusted Ventilatory Assist on Lung Ultrasound Aeration and Diaphragmatic Function in Extremely Preterm Infants With Evolving or Established Bronchopulmonary Dysplasia.
4 affiliations
- 1Neonatal Intensive Care Centre, St George's University Hospitals NHS Foundation Trust, London, UK.
- 2Department of Neonatology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK.
- 3City St George's University of London, London, UK.
- 4Faculty of Life Sciences and Medicine, King's College London, UK.
Abstract
Background
Neurally adjusted ventilatory assist (NAVA) delivers ventilatory support proportional to diaphragmatic electrical activity, improving patient-ventilator synchrony. Its effects on lung aeration and diaphragmatic workload in extremely preterm infants have not been well characterized.Objectives
We hypothesized that initiation of NAVA in preterm infants born at < 32 weeks' gestation would result in improved lung recruitment while allowing effective ventilation at lower airway pressures without increasing diaphragmatic workload.Methods
This prospective observational pilot study was conducted in a tertiary neonatal intensive care unit. Nineteen preterm infants (median gestational age 24 + 5 weeks; median birth weight 700 g, range 380-1352 g) were transitioned to NAVA at a median postnatal age of 30 + 5 days according to a pre-specified unit protocol. Lung ultrasound aeration scores (LUS), diaphragmatic excursion and thickness, peak electrical diaphragmatic activity (EAdi peak), mean airway pressure (MAP), and FiO₂ were measured immediately before and 1 h after NAVA initiation. Paired statistical analyses were performed.Results
LUS decreased markedly following NAVA initiation (mean 15.21 ± 3.26 vs. 7.11 ± 2.47; p < 0.001; Cohen's d = 3.02), with the effect observed in both invasive and non-invasive NAVA groups. MAP decreased significantly (11.82 ± 1.63 vs. 9.56 ± 1.64 cmH₂O; p < 0.001) and FiO₂ showed a non-significant trend towards improvement (0.35 vs. 0.32; p = 0.020). Diaphragmatic excursion (7.05 ± 2.1 vs. 6.7 ± 2.2 mm; p = 0.650) and EAdi peak (8.4 vs. 8.3 mV; p = 0.839) were unchanged.Conclusions
In this pilot cohort, initiation of NAVA in extremely preterm infants was associated with rapid improvement in lung ultrasound aeration scores and reduced ventilatory pressures, without evidence of increased diaphragmatic loading. These findings are hypothesis-generating and larger controlled studies are needed to confirm them.
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BibTeX
@article{kulkarni2026effects,
title = {{Effects of Neurally Adjusted Ventilatory Assist on Lung Ultrasound Aeration and Diaphragmatic Function in Extremely Preterm Infants With Evolving or Established Bronchopulmonary Dysplasia.}},
author = {Anay Kulkarni and Justin Richards and Touqueer Fatima and Shavindra Chellen and Donovan Duffy and Sandeep Shetty},
journal = {Pediatric pulmonology},
year = {2026},
month = oct,
doi = {10.1002/ppul.71885},
url = {https://europepmc.org/article/MED/42895257},
note = {CC BY},
}
RIS
TY - JOUR
TI - Effects of Neurally Adjusted Ventilatory Assist on Lung Ultrasound Aeration and Diaphragmatic Function in Extremely Preterm Infants With Evolving or Established Bronchopulmonary Dysplasia.
AU - Anay Kulkarni
AU - Justin Richards
AU - Touqueer Fatima
AU - Shavindra Chellen
AU - Donovan Duffy
AU - Sandeep Shetty
PY - 2026
DA - 2026/10/01
JO - Pediatric pulmonology
DO - 10.1002/ppul.71885
UR - https://europepmc.org/article/MED/42895257
AB - Background Neurally adjusted ventilatory assist (NAVA) delivers ventilatory support proportional to diaphragmatic electrical activity, improving patient-ventilator synchrony. Its effects on lung aeration and diaphragmatic workload in extremely preterm infants have not been well characterized.Objectives We hypothesized that initiation of NAVA in preterm infants born at < 32 weeks' gestation would result in improved lung recruitment while allowing effective ventilation at lower airway pressures without increasing diaphragmatic workload.Methods This prospective observational pilot study was conducted in a tertiary neonatal intensive care unit. Nineteen preterm infants (median gestational age 24 + 5 weeks; median birth weight 700 g, range 380-1352 g) were transitioned to NAVA at a median postnatal age of 30 + 5 days according to a pre-specified unit protocol. Lung ultrasound aeration scores (LUS), diaphragmatic excursion and thickness, peak electrical diaphragmatic activity (EAdi peak), mean airway pressure (MAP), and FiO₂ were measured immediately before and 1 h after NAVA initiation. Paired statistical analyses were performed.Results LUS decreased markedly following NAVA initiation (mean 15.21 ± 3.26 vs. 7.11 ± 2.47; p < 0.001; Cohen's d = 3.02), with the effect observed in both invasive and non-invasive NAVA groups. MAP decreased significantly (11.82 ± 1.63 vs. 9.56 ± 1.64 cmH₂O; p < 0.001) and FiO₂ showed a non-significant trend towards improvement (0.35 vs. 0.32; p = 0.020). Diaphragmatic excursion (7.05 ± 2.1 vs. 6.7 ± 2.2 mm; p = 0.650) and EAdi peak (8.4 vs. 8.3 mV; p = 0.839) were unchanged.Conclusions In this pilot cohort, initiation of NAVA in extremely preterm infants was associated with rapid improvement in lung ultrasound aeration scores and reduced ventilatory pressures, without evidence of increased diaphragmatic loading. These findings are hypothesis-generating and larger controlled studies are needed to confirm them.
SN - 8755-6863
SN - 1099-0496
ER -