Novel Method of CPAP Delivery in Neonates With Apnea of Prematurity Using NIV NAVA

Abstract

Background:

Premature neonates often fail nasal CPAP due to prematurity of apnea (AOP). When the neonate is apneic, CPAP provides inadequate additional support and neonates decompensate clinically. Current CPAP modalities do not allow backup ventilation that occurs only with the apneic event. Neurally-adjusted ventilatory assist (NAVA) provides support in proportion to the electrical activity of the diaphragm (EAdi). The NAVA level converts the EAdi into a proportional pressure that varies breath to breath. When there is no EAdi for a set amount of time the ventilator goes into pressure control (backup) ventilation at a preset rate providing support until spontaneous respiration resumes.

Methods:

Retrospective single center study of neonates having clinically significant events (CSE) due to AOP while on CPAP. At the discretion of the treating physician, they were placed on noninvasive NAVA with NAVA level of 0 cm H₂O/ mcV (NIV NAVA 0) and PEEP equal to the previous CPAP level. A pressure of 0 above PEEP (= CPAP) was delivered during spontaneous breathing and backup ventilation was provided when the infant became apneic for longer than a preset time until the infant resumed breathing. Demographics and number of CSE on 24 h of CPAP followed by 24 h on NIV NAVA 0 were collected. Statistics were paired t-test. IRB approval was obtained.

Results:

16 neonates qualified for the study. All were on CPAP, had AOP and were on Caffeine. Birth weight was 882+164 g, gestational age was 26+1.7 weeks, weight at study was 917+224 g and age at study was 20+12 d. CSE decreased from 17.9+7.8 on CPAP to 10.6+8.1 events on NIV NAVA 0 (P= 0.0008).

Conclusions:

NIV NAVA 0 reduced the number of CSE compares to CPAP in premature neonates with apnea. This may decrease the need for intubation in neonates failing CPAP due to malignant apnea.