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

Robin L. McKinney; Martin Keszler; William E. Truog; Michael Norberg; Richard Sindelar; Linda Wallström; Bruce Schulman; Jason Gien; Steven H. Abman; on behalf of the Bronchopulmonary Dysplasia Collaborative

doi:10.1055/s-0040-1708559

American Journal of Perinatology, Table of Contents

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

¹Department of Pediatric Critical Care Medicine, Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, Rhode Island

,

Martin Keszler

²Department of Pediatrics, Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island

,

William E. Truog

³Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri

,

Michael Norberg

⁴Department of Neonatology, Children's Mercy Hospital, Kansas City, Missouri

,

Richard Sindelar

⁵Division of Neonatology, Department of Women's and Children's Health Uppsala University Children's Hospital, Uppsala, Sweden

,

Linda Wallström

⁵Division of Neonatology, Department of Women's and Children's Health Uppsala University Children's Hospital, Uppsala, Sweden

,

Bruce Schulman

⁶Department of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, Florida

,

Jason Gien

⁷Department of Pediatrics, University of Colorado Anschutz Medical Center and Children's Hospital Colorado, Aurora, Colorado

,

Steven H. Abman

⁸Department of Pediatrics, University of Colorado Anschutz Medical Center and Children's Hospital Colorado, Aurora, Colorado

,

on behalf of the Bronchopulmonary Dysplasia Collaborative

› Author Affiliations

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

Full Text

References

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