Neurally adjusted ventilatory assist improves survival, and its early application accelerates weaning in preterm infants.

Background: Evidence to show that neurally adjusted ventilatory assist (NAVA) improves clinical outcomes is lacking. We aimed to analyze whether NAVA improves respiratory outcomes in preterm infants who require invasive mechanical ventilation.

Methods: A retrospective cohort study was conducted in 122 very low birthweight infants who required invasive mechanical ventilation for more than 24 h 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 seventh day of life (n = 18), late NAVA for those supported with NAVA later than the seventh day (n = 18), and conventional for those supported with conventional ventilation modes other than NAVA (n = 86).

Results: There was no difference in the composite outcome of bronchopulmonary dysplasia or death among the three groups. Neonates who had been supported with NAVA at some point had lower odds of mortality than those who had not (adjusted odds ratio [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 within the first week of life than in those supported with other ventilation modes (aHR 2.02, 95% CI 1.14-3.57, p = 0.015).

Conclusions: Neurally adjusted ventilatory assist 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.