Non-Invasive Ventilation with Neurally Adjusted Ventilatory Assist (NAVA) Improves Extubation Outcomes in Extremely Low-Birth-Weight Infants

Abstract

Objective: This study investigates the effectiveness of extubation from conventional mechanical ventilation using an endotracheal tube (MVET) compared to synchronized non-invasive positive-pressure ventilation (sNIPPV) using neurally adjusted ventilatory assist (NAVA) and conventional non-invasive positive-pressure ventilation (NIPPV) in extremely low-birth-weight (ELBW) infants. Methods: An institutional review board (IRB) approved this study (#12175) to conduct a single-center randomized control trial including 60 ELBW infants assigned in a one-to-one computer-generated scheme to either sNIPPV using NAVA or NIPPV. The primary outcome involved the need for reintubation, and the secondary outcome involved the assessment of moderate/severe BPD, defined as an oxygen requirement at 36 weeks, as in #NCT03613987 (clinicaltrials.gov). Results: There were 60 ELBW infants enrolled and randomized. The overall gestational age was 26 (1.5) weeks, and the birth weight was 773 (157) g [mean (SD)]. There were no statistically significant differences between the NAVA and NIPPV patient characteristics. There was a 41% extubation failure rate in the NIPPV group and 35% in the NAVA group (p = NS). The NAVA group had less moderate and severe BPD (p = 0.03), a shorter oxygen therapy duration (p = 0.002), a decreased length of stay (p = 0.03), and less need for home oxygen (0, 43%; p = 0.0004). Conclusions: This study found similar extubation failure rates among ELBW infants as in prior studies. However, the NAVA group had lower rates of moderate/severe BPD and need for oxygen at discharge, as well as shorter oxygen therapy duration and length of stay. The use of NAVA may be a reasonable alternative mode of non-invasive ventilation in the ELBW population.

Keywords: bronchopulmonary dysplasia; extremely low birth weight; neurally adjusted ventilatory assist; non-invasive positive-pressure ventilation.

Figure 1

Consort diagram of neonates shown after exclusions and randomization. NIPPV, Non-invasive positive-pressure ventilation; NAVA, neurally adjusted ventilatory assist.

Figure 2

As-treated outcomes comparing mode of non-invasive ventilation. Figure 2 compares the proportion of infants in the NIPPV and NAVA groups in various outcomes such as the incidence of extubation failure, pneumothorax, diuretics use, moderate and severe BPD, and oxygen therapy at discharge. (* p = <0.05. NIPPV, non-invasive positive-pressure ventilation; NAVA, neurally adjusted ventilatory assist; BPD bronchopulmonary dysplasia; D/C, discharge).

Figure 3

As-treated outcomes comparing modes of non-invasive ventilation. Figure 3 compares the number of infants in the NIPPV to the NAVA group in various outcomes: the day of life when an infant was extubated, the duration of oxygen therapy, and the length of hospital stay in the NICU. (* p = <0.05. DOL, day of life; NICU, neonatal intensive care unit; blue for NIPPV; green for NAVA).