Faculty Bibliography

OBJECTIVE:To compare the electrical activity of the diaphragm (Edi) of premature infants placed on continuous positive airway pressure (CPAP) with the Edi of premature infants placed on noninvasive neurally adjusted ventilatory assist (NIV NAVA). The secondary aim was to evaluate the feasibility of the use of NIV NAVA mode in the busy tertiary neonatal unit. STUDY DESIGN/METHODS:This was a prospective crossover pilot study of premature infants requiring noninvasive respiratory support. Infants were randomized to initially receive either CPAP/biphasic (group 1) or NIV NAVA (group 2) and were then crossed over to the alternate group. Continuous Edi signals were recorded for 24 h, with 12 h each on CPAP/biphasic, and NIV NAVA along with other clinical and respiratory parameters.  Results: Ten infants with a mean gestation age of 29 weeks (range 25-34 weeks) were enrolled, with a total cumulative Edi monitoring of 240 h. The average Edi peak on the biphasic/CPAP group (15.6 ± 7 mcV) was significantly higher (P < 0.005), compared to the Edi Peak on the NIV NAVA group (10.8 ± 3.3 mcV). The Edi min values were 3.23 ± 1.1 mcV, and 3.07 ± 0.5 mcV on CPAP/biphasic and NIV NAVA (P = 0.69) respectively. There were no significant differences in other clinical parameters between the two groups. No major adverse events were recorded during Edi catheter monitoring. CONCLUSION/CONCLUSIONS:The Edi peak values were significantly lower in NIV NAVA mode compared to CPAP/biphasic mode. The Edi catheter and NIV NAVA may also be used safely in premature infants.

Background Earlier initiation of therapeutic hypothermia in term infants with hypoxic-ischemic encephalopathy has been shown to improve neurological outcomes. The objective of the study was to compare safety and effectiveness of servo-controlled active vs. passive cooling used during neonatal transport in achieving target core temperature. Methods We undertook a prospective cohort quality improvement study with historic controls of therapeutic hypothermia during transport. Primary outcome measures were analyzed: time to cool after initiation of transport, time to achieve target temperature from birth and temperature on arrival to cooling centers. Safety was assessed by group comparison of vital signs, diagnosis of persistent pulmonary hypertension (PPHN) and coagulation profiles on arrival. Results A total of 65 infants were included in the study. Time to cool after initiation of transport and time to achieve target temperature from birth were statistically significantly shorter in the actively cooled group with time reduction of 24% with P<0.01 and 15.6% with P<0.01, respectively. On arrival to our cooling center, we noted a significance difference in the mean core temperature (active 33.8°C vs. passive 35.4°C, P<0.01). Seven percent (2/30) of infants in the passively cooled group were overcooled (temperature <33°C). Patients in the actively cooled group had significantly lower mean heart rate compared to the passively cooled group. There was no statistically significant difference in diagnosis of PPHN or coagulation profiles on admission. Conclusions Our study indicates that active cooling with a servo-controlled device on neonatal transport is safe and more effective in achieving target temperature compared to passive cooling.