Non-invasive Neurally Adjusted Ventilatory Assist (NIV-Nava): Four-Year Experience in a Level III Neonatal Intensive Care Unit

IntroductionNon-invasive neurally adjusted ventilatory assist (NIV-NAVA) is a ventilation mode that uses the electrical activity of the diaphragm to synchronize respiratory support with the patient's spontaneous effort.It has emerged as a promising non-invasive modality for neonates.We aimed to evaluate the clinical success of NIV-NAVA in a neonatal intensive care unit (NICU) setting.To our knowledge, this is the first study in Portugal to describe the experience with NIV-NAVA in a level III NICU. MethodsWe conducted an observational retrospective cohort study through a medical record review over four years (January 2021 to December 2024).All newborns admitted to our NICU who were ventilated using NIV-NAVA were included.Descriptive statistical analysis was performed on demographic and diagnostic data.Ventilatory and gasometrical parameters, including fraction of inspired oxygen (FiO₂), pH, and partial pressure of carbon dioxide (pCO₂), were evaluated before and after NIV-NAVA initiation.A respiratory severity score (RSS) was calculated at baseline to assess the severity of respiratory disease.The primary outcome was the proportion of NIV-NAVA episodes not requiring subsequent endotracheal intubation, and success was defined as the avoidance of subsequent intubation. ResultsA total of 36 NIV-NAVA episodes were recorded across 28 newborns, with a mean gestational age of 26 weeks and a mean birth weight of 822g.All newborns were diagnosed with prematurity, respiratory distress syndrome, and bronchopulmonary dysplasia.The mean baseline RSS was 3.7, reflecting the respiratory disease burden at NIV-NAVA initiation.NIV-NAVA was initiated following extubation in 83.3% of cases and as therapeutic escalation in 16.7%.Success was achieved in 58.3% of all episodes (60% in the postextubation group and 50% in the escalation group).No statistically significant differences were observed in mean FiO₂ or pCO₂ values before and after NIV-NAVA. DiscussionNIV-NAVA success was observed in the majority of newborns, including extremely low birth weight infants with clinically relevant respiratory disease burden.While NIV-NAVA offers significant theoretical advantages regarding patient-ventilator synchronization, published evidence in the NICU remains limited. ConclusionOur findings support the use of NIV-NAVA as a feasible non-invasive ventilatory modality in preterm infants, particularly for post-extubation respiratory support, although further randomized controlled trials are warranted to better establish its role and efficacy within the neonatal population.