213 - Invasive Neurally Adjusted Ventilatory Assist (iNAVA) in Preterm Infants with Chronic Lung Disease (CLD)

Poster Number: 213
Publication Number: 213.3270

Background: Neurally adjusted ventilator assist is an underutilized mode of partial ventilatory support in which neural inspiratory activity is monitored through the continuous esophageal recording of the electrical activity of the diaphragm. NAVA is designed to improve patient-ventilator synchrony while maintaining spontaneous breathing. However, limited data exists regarding the application of iNAVA in intubated infants in the neonatal intensive care unit (NICU) for CLD management.

Objective: To evaluate the impact of iNAVA and short-term respiratory outcomes in preterm infants with CLD.

Design/Methods: Preterm infants < 30 weeks’ gestation admitted to the NICU of American Family Children’s Hospital in Madison, WI, between 7/1/2016 and 6/30/2022 who received iNAVA for >48 hours were included in the study. Infants with major congenital anomalies were excluded. Clinical and demographic data were gathered through chart reviews. Respiratory characteristics (mean airway pressure [MAP], fraction of oxygen [FiO2], and respiratory severity score [RSS], a product of MAP x FiO2) were summarized using the median and interquartile range (IQR) and were compared pre-iNAVA, 48 hours post-iNAVA, and 7 days post-iNAVA.

Results: For 16 preterm infants analyzed, the median gestational age was 25.5 (IQR 24.8, 26.8) weeks, and the median birth weight was 785 (IQR 635, 885) grams. The median post-menstrual age (PMA) at iNAVA initiation was 35.5 weeks (IQR 33.2, 39.0 weeks). Significant improvements were noted in FiO2 (0.40 vs 0.32, p=0.004) and RSS (4.8 vs 3.6, p=0.025) 48 hours post-iNAVA initiation. For infants with an initial RSS >4, there was a marked improvement in FiO2 (from 0.49 to 0.38, p=0.004) and RSS at 48 hours (from 6.5 to 4.8, p=0.025). Of the infants, six remained on iNAVA at 7 days, continuing to demonstrate reduced FiO2 (0.5 to 0.3) and RSS (7 to 3.4).

Conclusion(s): The use of iNAVA in preterm infants with CLD resulted in an improvement of RSS at 48 hours and 7 days post iNAVA initiation. The utility of iNAVA in the management of CLD needs to be evaluated in large prospective cohort studies and/or randomized clinical trials.