Neurally adjusted ventilatory assist decreases the requirement of corticosteroids

This study aimed to evaluate the incidence of bronchopulmonary dysplasia (BPD) and the dosage of corticosteroids in extremely preterm infants with the implementation of neurally adjusted ventilatory assist (NAVA).

This is a historical cohort study of extremely preterm infants. We compared the incidence of BPD and the dosage of corticosteroids between the two eras: pre-NAVA era (from April 2014 to December 2017) and post-NAVA era (from January 2019 to March 2023). Other respiratory management strategies (including the indication of corticosteroids) did not change during this study period.

Sixty-four extremely preterm infants were born and admitted to our neonatal intensive care unit. After exclusion of ineligible infants, 23 were from the pre-NAVA era and 37 were from the post-NAVA era. Although the number of mechanical ventilation days tended to be longer in the post-NAVA era, the incidence of BPD at 36 and 40 weeks of postmenstrual age did not increase in the post-NAVA era. The total dosage of corticosteroids was significantly decreased in the post-NAVA era compared with the pre-NAVA era (14 mg/kg [interquartile range 0-27] vs. 50 mg/kg [13-70], p = 0.004).

Although the duration of mechanical ventilation tended to be longer in the post-NAVA era than in the pre-NAVA era, the incidence of BPD did not increase, and the dosage of corticosteroid decreased after implementing NAVA. These results suggest that NAVA prevents lung damage from mechanical ventilation.