Feasibility of invasive neurally-adjusted ventilatory assist in severe congenital diaphragmatic hernia.

OBJECTIVE

To evaluate the feasibility and early physiologic effects of postoperative invasive neurally-adjusted ventilatory assist (NAVA) in neonates with severe congenital diaphragmatic hernia (CDH).

STUDY

DESIGN

Retrospective observational study of inborn neonates with CDH who received invasive NAVA during the post-repair ventilator weaning phase. Ventilator parameters, blood gas variables, respiratory indices, and diaphragm-based efficiency measures were evaluated serially within infants at 0, 12, 24, and 48 hours after NAVA initiation.

RESULTS

Of 123 inborn infants with CDH, 19 with high disease severity received postoperative invasive NAVA. Oxygen requirements decreased over time, with favorable changes in gas exchange by 48 hours. The oxygenation index declined without increased ventilator pressures. Neuroventilatory and neuromechanical efficiency remained stable, including in infants with type D defects. All infants were successfully weaned from invasive mechanical ventilation.

CONCLUSIONS

Postoperative invasive NAVA was feasible and well tolerated in neonates with severe CDH, including those with type D defects and prior extracorporeal membrane oxygenation support.