Effects of Neurally Adjusted Ventilatory Assist on Lung Ultrasound Aeration and Diaphragmatic Function in Extremely Preterm Infants With Evolving or Established Bronchopulmonary Dysplasia
In brief
NAVA nearly halves lung ultrasound scores in 19 extremely preterm infants
One hour after starting neurally adjusted ventilatory assist, infants' average lung ultrasound score fell from 15.2 to 7.1, indicating better aeration, while mean airway pressure also decreased. Diaphragm movement and electrical activity were unchanged, but this small observational pilot cannot show that NAVA caused the improvement; larger controlled studies are needed.
- Journal
- Pediatric pulmonology (Q1)
- Published
- 1 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Anay Kulkarni, Justin Richards, Touqueer Fatima, Shavindra Chellen, Donovan Duffy, Sandeep Shetty
- PMID
- 42895257
- DOI
- 10.1002/ppul.71885
Why clinicians should know about it
- Picked for Neonatology (paper of the day, 20 October 2026): Pilot study of NAVA improving lung aeration in extremely preterm
Abstract
BACKGROUND: Neurally adjusted ventilatory assist (NAVA) delivers ventilatory support proportional to diaphragmatic electrical activity, improving patient-ventilator synchrony. Its effects on lung aeration and diaphragmatic workload in extremely preterm infants have not been well characterized. OBJECTIVES: We hypothesized that initiation of NAVA in preterm infants born at < 32 weeks' gestation would result in improved lung recruitment while allowing effective ventilation at lower airway pressures without increasing diaphragmatic workload. METHODS: This prospective observational pilot study was conducted in a tertiary neonatal intensive care unit. Nineteen preterm infants (median gestational age 24 + 5 weeks; median birth weight 700 g, range 380-1352 g) were transitioned to NAVA at a median postnatal age of 30 + 5 days according to a pre-specified unit protocol. Lung ultrasound aeration scores (LUS), diaphragmatic excursion and thickness, peak electrical diaphragmatic activity (EAdi peak), mean airway pressure (MAP), and FiO2 were measured immediately before and 1 h after NAVA initiation. Paired statistical analyses were performed. RESULTS: LUS decreased markedly following NAVA initiation (mean 15.21 ± 3.26 vs. 7.11 ± 2.47; p < 0.001; Cohen's d = 3.02), with the effect observed in both invasive and non-invasive NAVA groups. MAP decreased significantly (11.82 ± 1.63 vs. 9.56 ± 1.64 cmH2O; p < 0.001) and FiO2 showed a non-significant trend towards improvement (0.35 vs. 0.32; p = 0.020). Diaphragmatic excursion (7.05 ± 2.1 vs. 6.7 ± 2.2 mm; p = 0.650) and EAdi peak (8.4 vs. 8.3 mV; p = 0.839) were unchanged. CONCLUSIONS: In this pilot cohort, initiation of NAVA in extremely preterm infants was associated with rapid improvement in lung ultrasound aeration scores and reduced ventilatory pressures, without evidence of increased diaphragmatic loading. These findings are hypothesis-generating and larger controlled studies are needed to confirm them.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.