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Nasal continuous positive airway pressure versus noninvasive NAVA in preterm neonates with apnea of prematurity: a pilot study with a novel approach

Journal of Perinatology volume 40, pages 1211–1215 (2020)Cite this article

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Abstract

Background

Neonates with apnea of prematurity often fail CPAP because it does not provide adequate support during apnea. NAVA provides proportional ventilator support based on electrical activity of the diaphragm. When the NAVA level is 0 cmH20/mcV, the patient receives minimal support above PEEP when breathing and backup ventilation when apneic. This study compares number of clinically significant events on CPAP versus noninvasive NAVA level 0.

Methods

Retrospective study of preterm neonates having apnea of prematurity on nasal CPAP. Patients were then placed on NAVA level 0. The number of events on each mode was collected. Statistics were paired t-test.

Results

Seventeen subjects with gestational age 26.1 ± 1.7 weeks, study age 19.5 ± 12.5 days. Events decreased from 17.9 ± 7.8 on CPAP to 10.2 ± 8.1 events on NAVA level 0 (p = 0.00047).

Conclusions

NAVA level 0 reduced the number of clinically significant events compared with CPAP in premature neonates with apnea of prematurity.

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Fig. 1: Periods of apnea while on CPAP.
Fig. 2: Period of apnea when on noninvasive pressure support ventilation.
Fig. 3: Period of apnea when on noninvasive NAVA.
Fig. 4: Clinically significant events CSE were defined as apnea lasting more than 20 s, apnea for more than 10 s accompanied by bradycardia (<80 bpm) or desaturation (<90%).

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Author information

Authors and Affiliations

  1. Akron Children’s Hospital, Akron, OH, USA

    Kimberly Firestone

  2. Valley Children’s Hospital, Madera, CA, USA

    Bassel Al Horany

  3. ProMedica Russell J. Ebeid Children’s Hospital, Toledo, OH, USA

    Laurence de Leon-Belden & Howard Stein

  4. College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA

    Howard Stein

Authors
  1. Kimberly Firestone
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  2. Bassel Al Horany
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  3. Laurence de Leon-Belden
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  4. Howard Stein
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Contributions

HS, LB, and KF contributed to the study design. HS, LB, and BAH contributed to data collection. All authors contributed in writing the manuscript.

Corresponding author

Correspondence to Howard Stein.

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Conflict of interest

HS and KF are on the speakers’ bureau for Getinge and Chiesi USA Inc. BAH and LB have nothing to disclose.

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Firestone, K., Horany, B.A., de Leon-Belden, L. et al. Nasal continuous positive airway pressure versus noninvasive NAVA in preterm neonates with apnea of prematurity: a pilot study with a novel approach. J Perinatol 40, 1211–1215 (2020). https://doi.org/10.1038/s41372-020-0661-x

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