Neurally Adjusted Ventilatory Assist Improves Survival, and Its Early Application Accelerates Weaning From Mechanical Ventilation in Preterm Infants

초록

Background and Aims: To analyze whether neurally adjusted ventilatory assist (NAVA) improves respiratory outcomes in preterm infants who require invasive mechanical ventilation. Methods: A retrospective cohort study was conducted in 122 very low birth weight infants who required invasive mechanical ventilation for more than 24 hours at one tertiary neonatal intensive care unit in Korea from January 2016 to June 2023. Subjects were divided into three groups: early NAVA for those supported with NAVA before the 7th day of life (n = 18), late NAVA for those supported with NAVA after the 7th day (n = 18), and conventional for those supported with other conventional ventilation modes except NAVA (n = 86). Results: There was no difference in the composite outcome of bronchopulmonary dysplasia or death among the three groups. Neonates who had ever been supported with NAVA had lower odds of mortality than those who had not (aOR 0.09, 95% CI 0.01–0.90, p = 0.040 for the early NAVA group; aOR 0.15, 95% CI 0.03–0.81, p = 0.027 for the late NAVA group). The adjusted hazard ratio for invasive mechanical ventilation weaning was higher in neonates supported with NAVA before the 7th day of life than in those supported with other ventilation modes (aHR 2.02, 95% CI 1.14–3.57, p = 0.015). Conclusions: NAVA application was associated with lower odds of mortality, and its early application from the first few days of life helped preterm infants wean from invasive mechanical ventilation sooner.