Neurally adjusted ventilatory assist in neonates with congenital diaphragmatic hernia: reduced sedation and ventilatory support and preserved patient comfort

Introduction: Congenital diaphragmatic hernia (CDH) is a rare and severe condition requiring mechanical ventilation before and after surgery. Neurally adjusted ventilatory assist (NAVA) has demonstrated benefits in neonates with CDH, including improved patient-ventilator synchrony, reduced peak inspiratory pressure, and reduced sedation-analgesia requirements. The aim of this study was to evaluate the impact of NAVA initiation on sedation-analgesia, comfort scores, and ventilatory parameters in neonates with CDH. Patients and Methods: This retrospective single-center study included all neonates with CDH who were ventilated with NAVA from 2014 to 2022. Sedation-analgesia drug doses, comfort scores, and ventilatory parameters were compared 24 h before and after initiation of NAVA. Results: 28 NAVA ventilation periods were analyzed in 21 patients. NAVA initiation was associated with significant reductions in midazolam and fentanyl doses from (median [interquartile range]) 33 [26–75] to 17 [0–34] µg/kg/h (n = 21, p = 0.0004) and from 1.10 [1.00–1.25] to 0.00 [0.00–0.95] µg/kg/h (n = 11, p = 0.006), respectively. Ketamine doses also decreased, but non-significantly, from 0.90 [0.65–1.00] to 0.15 [0.00–0.54] mg/kg/h (p = 0.10). Morphine and dexmedetomidine doses and comfort scores (COMFORT-B, DAN, EDIN) were similar before and after NAVA initiation. Peak inspiratory pressure and fraction of inspired oxygen decreased significantly after NAVA initiation, respectively from 21 [19–22] to 16 [13–20] cmH 2 O (n = 13, p = 0.020) and from 0.30 [0.25–0.41] to 0.25 [0.21–0.31] (n = 28, p = 0.013) . Conclusion: In this group of neonates with CDH, NAVA initiation was associated with reduced sedation-analgesia doses and ventilatory parameters with no decrease in patient comfort. These results support the use of NAVA to wean neonates with CDH from mechanical ventilation.