Transition from high‐frequency oscillation ventilation to neurally adjusted ventilatory assist in extremely preterm infants

Background Bronchopulmonary dysplasia (BPD) affects long‐term respiratory function. Since oxygen toxicity and ventilator‐induced lung injury harm immature lungs and contribute to BPD development, careful ventilator management is essential. Reports comparing neurally adjusted ventilation assist (NAVA) with high‐frequency oscillation ventilation (HFOV) in extremely preterm infants are limited. This study aimed to evaluate the impact of transitioning from HFOV to NAVA on oxygenation in extremely preterm infants. Methods A retrospective cohort study was conducted on infants born at <27 weeks' of gestation at Osaka Women's and Children's Hospital, Japan between January 2021 and May 2023. Minute‐by‐minute data were collected for 72 h before and after transitioning from HFOV to NAVA. The Wilcoxon signed‐rank test compared the baseline characteristics and outcomes of infants for each period. Results Twenty‐three infants (27 transition attempts) were included in this study. The median gestational age was 24.7 (24.4–25.2) weeks, the median birth weight was 656 (609–721) g, and the median postmenstrual age during the study period was 28.3 (27.9–29.6) weeks. NAVA significantly improved the fractional inspiratory oxygen (F I O 2 ) (0.27 [0.25–0.30] vs. 0.30 [0.28–0.34], p < 0.01), oxygen saturation index (OSI) (2.74 [2.51–3.29] vs. 3.67 [3.28–4.54], p < 0.01), and mean airway pressure (MAP) (9.8 [9.5–10.1] vs. 12.0 [10.2–12.5], p < 0.01) compared with the values of these parameters during HFOV. The fluctuations in oxygen saturation tended to be higher with NAVA (3.2 [2.6–3.7] vs. 2.4 [1.8–3.0], p < 0.01) compared with HFOV. Conclusions In extremely preterm infants, transitioning from HFOV to NAVA showed significant improvements in the OSI, F I O 2 , and MAP.