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Am J Perinatol 2021; 38(S 01): e162-e166
DOI: 10.1055/s-0040-1708559
Original Article

Multicenter Experience with Neurally Adjusted Ventilatory Assist in Infants with Severe Bronchopulmonary Dysplasia

Robin L. McKinney
1   Department of Pediatric Critical Care Medicine, Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, Rhode Island
,
Martin Keszler
2   Department of Pediatrics, Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island
,
William E. Truog
3   Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
,
Michael Norberg
4   Department of Neonatology, Children's Mercy Hospital, Kansas City, Missouri
,
Richard Sindelar
5   Division of Neonatology, Department of Women's and Children's Health Uppsala University Children's Hospital, Uppsala, Sweden
,
Linda Wallström
5   Division of Neonatology, Department of Women's and Children's Health Uppsala University Children's Hospital, Uppsala, Sweden
,
Bruce Schulman
6   Department of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, Florida
,
Jason Gien
7   Department of Pediatrics, University of Colorado Anschutz Medical Center and Children's Hospital Colorado, Aurora, Colorado
,
Steven H. Abman
8   Department of Pediatrics, University of Colorado Anschutz Medical Center and Children's Hospital Colorado, Aurora, Colorado
,
on behalf of the Bronchopulmonary Dysplasia Collaborative › Author Affiliations
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Abstract

Objective The aim of this study is to determine patterns of neurally adjusted ventilatory assist (NAVA) use in ventilator-dependent preterm infants with evolving or established severe bronchopulmonary dysplasia (sBPD) among centers of the BPD Collaborative, including indications for its initiation, discontinuation, and outcomes.

Study Design Retrospective review of infants with developing or established sBPD who were placed on NAVA after ≥4 weeks of mechanical ventilation and were ≥ 30 weeks of postmenstrual age (PMA).

Results Among the 13 sites of the BPD collaborative, only four centers (31%) used NAVA in the management of infants with evolving or established BPD. A total of 112 patients met inclusion criteria from these four centers. PMA, weight at the start of NAVA and median number of days on NAVA, were different among the four centers. The impact of NAVA therapy was assessed as being successful in 67% of infants, as defined by the ability to achieve respiratory stability at a lower level of ventilator support, including extubation to noninvasive positive pressure ventilation or support with a home ventilator. In total 87% (range: 78–100%) of patients survived until discharge.

Conclusion We conclude that NAVA can be used safely and effectively in selective infants with sBPD. Indications and current strategies for the application of NAVA in infants with evolving or established BPD, however, are highly variable between centers. Although this pilot study suggests that NAVA may be successfully used for the management of infants with BPD, sufficient experience and well-designed clinical studies are needed to establish standards of care for defining the role of NAVA in the care of infants with sBPD.

Keywords

neurally adjusted ventilatory assist - severe bronchopulmonary dysplasia - mechanical ventilation


Publication History

Received: 07 October 2019

Accepted: 13 February 2020

Article published online:
24 March 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 2015; 314 (10) 1039-1051
    CrossrefPubMedGoogle Scholar
  • 2 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
    CrossrefPubMedGoogle Scholar
  • 3 Abman SH, Collaco JM, Shepherd EG. et al; Bronchopulmonary Dysplasia Collaborative. interdisciplinary care of children with severe bronchopulmonary dysplasia. J Pediatr 2017; 181: 12-28.e1
    CrossrefPubMedGoogle Scholar
  • 4 Gien J, Kinsella J, Thrasher J, Grenolds A, Abman SH, Baker CD. Retrospective analysis of an interdisciplinary ventilator care program intervention on survival of infants with ventilator-dependent bronchopulmonary dysplasia. Am J Perinatol 2017; 34 (02) 155-163
    PubMedGoogle Scholar
  • 5 Lee J, Kim H-S, Jung YH. et al. Non-invasive neurally adjusted ventilatory assist in preterm infants: a randomised phase II crossover trial. Arch Dis Child Fetal Neonatal Ed 2015; 100 (06) F507-F513
    CrossrefPubMedGoogle Scholar
  • 6 Jung YH, Kim H-S, Lee J, Shin SH, Kim E-K, Choi J-H. neurally adjusted ventilatory assist in preterm infants with established or evolving bronchopulmonary dysplasia on high-intensity mechanical ventilatory support: a single-center experience. Pediatr Crit Care Med 2016; 17 (12) 1142-1146
    CrossrefPubMedGoogle Scholar
  • 7 Rosterman JL, Pallotto EK, Truog WE. et al. The impact of neurally adjusted ventilatory assist mode on respiratory severity score and energy expenditure in infants: a randomized crossover trial. J Perinatol 2018; 38 (01) 59-63
    CrossrefPubMedGoogle Scholar
  • 8 Breatnach C, Conlon NP, Stack M, Healy M, O'Hare BP. A prospective crossover comparison of neurally adjusted ventilatory assist and pressure-support ventilation in a pediatric and neonatal intensive care unit population. Pediatr Crit Care Med 2010; 11 (01) 7-11
    CrossrefPubMedGoogle Scholar
  • 9 Piastra M, De Luca D, Costa R. et al. Neurally adjusted ventilatory assist vs pressure support ventilation in infants recovering from severe acute respiratory distress syndrome: nested study. J Crit Care 2014; 29 (02) 312.e1-312.e5
    CrossrefPubMedGoogle Scholar
  • 10 Kallio M, Peltoniemi O, Anttila E, Pokka T, Kontiokari T. Neurally adjusted ventilatory assist (NAVA) in pediatric intensive care--a randomized controlled trial. Pediatr Pulmonol 2015; 50 (01) 55-62
    CrossrefPubMedGoogle Scholar
  • 11 Kallio M, Koskela U, Peltoniemi O. et al. Neurally adjusted ventilatory assist (NAVA) in preterm newborn infants with respiratory distress syndrome-a randomized controlled trial. Eur J Pediatr 2016; 175 (09) 1175-1183
    CrossrefPubMedGoogle Scholar
  • 12 Lee J, Kim H-S, Jung YH, Choi CW, Jun YH. Neurally adjusted ventilatory assist for infants under prolonged ventilation. Pediatr Int (Roma) 2017; 59 (05) 540-544
    CrossrefPubMedGoogle Scholar
  • 13 Shetty S, Hunt K, Peacock J, Ali K, Greenough A. Crossover study of assist control ventilation and neurally adjusted ventilatory assist. Eur J Pediatr 2017; 176 (04) 509-513
    CrossrefPubMedGoogle Scholar
  • 14 Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 2006; 32 (10) 1515-1522
    CrossrefPubMedGoogle Scholar
  • 15 Napolitano N, Jalal K, McDonough JM. et al. Identifying and treating intrinsic PEEP in infants with severe bronchopulmonary dysplasia. Pediatr Pulmonol 2019; 54 (07) 1045-1051
    CrossrefPubMedGoogle Scholar
  • 16 Choi CW, Kim BI, Koh YY, Choi JH, Choi JY. Clinical characteristics of chronic lung disease without preceding respiratory distress syndrome in preterm infants. Pediatr Int 2005; 47 (01) 72-79
    CrossrefPubMedGoogle Scholar
  • 17 Choi CW, Kim BI, Park JD, Koh YY, Choi JH, Choi JY. Risk factors for the different types of chronic lung diseases of prematurity according to the preceding respiratory distress syndrome. Pediatr Int 2005; 47 (04) 417-423
    CrossrefPubMedGoogle Scholar
  • 18 Streubel AH, Donohue PK, Aucott SW. The epidemiology of atypical chronic lung disease in extremely low birth weight infants. J Perinatol 2008; 28 (02) 141-148
    CrossrefPubMedGoogle Scholar
  • 19 Egreteau L, Pauchard JY, Semama DS. et al. Chronic oxygen dependency in infants born at less than 32 weeks' gestation: incidence and risk factors. Pediatrics 2001; 108 (02) E26
    CrossrefPubMedGoogle Scholar
  • 20 Guaman MC, Gien J, Baker CD, Zhang H, Austin ED, Collaco JM. point prevalence, clinical characteristics, and treatment variation for infants with severe bronchopulmonary dysplasia. Am J Perinatol 2015; 32 (10) 960-967
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Lapcharoensap W, Gage SC, Kan P. et al. Hospital variation and risk factors for bronchopulmonary dysplasia in a population-based cohort. JAMA Pediatr 2015; 169 (02) e143676
    CrossrefPubMedGoogle Scholar
  • 22 Pettenuzzo T, Aoyama H, Englesakis M, Tomlinson G, Fan E. Effect of neurally adjusted ventilatory assist on patient-ventilator interaction in mechanically ventilated adults: a systematic review and meta-analysis. Crit Care Med 2019; 47 (07) e602-e609
    CrossrefPubMedGoogle Scholar
  • 23 Overman AE, Liu M, Kurachek SC. et al. Tracheostomy for infants requiring prolonged mechanical ventilation: 10 years' experience. Pediatrics 2013; 131 (05) e1491-e1496
    CrossrefPubMedGoogle Scholar