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Updated: Mar 12, 2026
Author Spotlight: Unraveling the Impact of Mechanical Ventilation on Diaphragm Function and Patient Outcomes
Published on: November 3, 2023
Diaphragmatic activity during weaning from respiratory support in preterm infants
Juliette V Kraaijenga1, Cornelia G de Waal1, Gerard J Hutten1
1Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Objective:
To determine if weaning from nasal continuous positive airway pressure (nCPAP) to lesser supportive low flow nasal cannula (LFNC) results in a change in electrical activity of the diaphragm in preterm infants.
Design:
Prospective observational study.
Setting:
Neonatal intensive care unit.
Patients:
Stable preterm infants weaned from nCPAP to LFNC (1 L/min).
Main Outcome Measures:
Change in diaphragmatic activity, expressed as amplitude, peak and tonic activity, measured by transcutaneous electromyography (dEMG) from 30 min before (baseline) until 180 min after weaning. Subgroup analysis was performed based on success or failure of the weaning attempt.
Results:
Fifty-nine preterm infants (gestational age: 29.0±2.4 weeks, birth weight: 1210±443 g) accounting for 74 weaning attempts were included. A significant increase in dEMG amplitude (median, IQR: 21.3%, 3.6-41.4), peak (22.1%, 8.7-40.5) and tonic activity (14.3%, -1.9-38.1) was seen directly after weaning. This effect slowly decreased over time. Infants failing the weaning attempt tended to have a higher diaphragmatic activity than those successfully weaned.
Conclusions:
Weaning from nCPAP to LFNC leads to an increase in diaphragmatic activity measured by dEMG and is most prominent in preterm infants failing the weaning attempt. dEMG monitoring might be a useful parameter to guide weaning from respiratory support in preterm infants.
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