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Neural breathing patterns in preterm newborns supported with non-invasive neurally adjusted ventilatory assist

Journal of Perinatology volume 38, pages 1235–1241 (2018)Cite this article

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Abstract

Objective

To characterize the neural breathing pattern in preterm infants supported with non-invasive neurally adjusted ventilatory assist (NIV-NAVA).

Study Design

Single-center prospective observational study. The electrical activity of the diaphragm (EAdi) was periodically recorded in 30-second series with the Edi catheter and the Servo-n software (Maquet, Solna, Sweden) in preterm infants supported with NIV-NAVA. The EAdiPeak, EAdiMin, EAdiTonic, EAdiPhasic, neural inspiratory, and expiratory times (nTi and nTe) and the neural respiratory rate (nRR) were calculated. EAdi curves were generated by Excel for visual examination and classified according to the predominant pattern.

Results

291 observations were analyzed in 19 patients with a mean GA of 27.3 weeks (range 24–36 weeks), birth weight 1028 g (510–2945 g), and a median (IQR) postnatal age of 18 days (4–27 days). The distribution of respiratory patterns was phasic without tonic activity 61.9%, phasic with basal tonic activity 18.6, tonic burst 3.8%, central apnea 7.9%, and mixed pattern 7.9%. In addition, 12% of the records showed apneas of >10 seconds, and 50.2% one or more “sighs”, defined as breaths with an EAdiPeak and/or nTi greater than twice the average EAdiPeak and/or nTi of the recording. Neural times were measurable in 252 observations. The nTi was, median (IQR): 279 ms (253–285 ms), the nTe 764 ms (642–925 ms), and the nRR 63 bpm (51–70), with a great intra and inter-subjects variability.

Conclusions

The neural breathing patterns in preterm infants supported with NIV-NAVA are quite variable and are characterized by the presence of significant tonic activity. Central apneas and sighs are common in this group of patients. The nTi seems to be shorter than the mechanical Ti commonly used in assisted ventilation.

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Acknowledgements

The authors thank all the nurses of the Neonatal Intensive Care Unit for their contribution to the collection of data and for their loving care of the patients and their families.

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Authors and Affiliations

  1. Neonatal Unit, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Avenida Marítima del Sur S/N, 35016, Las Palmas de Gran Canaria, Spain

    Fermín García-Muñoz Rodrigo, Lourdes Urquía Martí, Gloria Galán Henríquez & Sonia Rivero Rodríguez

  2. Informática de sistemas (Computer Systems), Madrid, Spain

    Alberto Hernández Gómez

Authors
  1. Fermín García-Muñoz Rodrigo
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  2. Lourdes Urquía Martí
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  3. Gloria Galán Henríquez
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Correspondence to Fermín García-Muñoz Rodrigo.

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García-Muñoz Rodrigo, F., Urquía Martí, L., Galán Henríquez, G. et al. Neural breathing patterns in preterm newborns supported with non-invasive neurally adjusted ventilatory assist. J Perinatol 38, 1235–1241 (2018). https://doi.org/10.1038/s41372-018-0152-5

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