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Respir Care. 2019 Jun 4. pii: respcare.06662. doi: 10.4187/respcare.06662. [Epub ahead of print]

Effects of Changes in Apnea Time on the Clinical Status of Neonates on NIV-NAVA.

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ProMedica Toledo Children's Hospital, Toledo, Ohio.
Akron Children's Hospital, Akron, Ohio.
Pediatrix Medical Group of Ohio, Akron, Ohio.
University of Toledo College of Medicine and Life Sciences, Toledo, Ohio.



Apnea time allows the clinician to set a minimum spontaneous respiratory frequency when using noninvasive neurally-adjusted ventilatory assist (NIV-NAVA). Short apnea times may provide backup ventilation during periods of physiologic variability causing overventilation and suppression of spontaneous respiratory drive. Longer apnea times may allow more spontaneous ventilation but can result in insufficient respiratory support. The purpose of this study was to evaluate various apnea times in neonates on NIV-NAVA.


This was a 2-center, prospective, 1-factorial, interventional study of < 30-week neonates on NIV-NAVA. Clinically significant events and ventilator data were recorded for apnea times of 2 s and 5 s for 2 h each.


15 neonates (26 ± 1.6 weeks gestational age, birthweight 893 ± 202 g) were studied. When compared to the 5-s apnea time, the 2-s apnea time showed increased switches into backup ventilation from 0.5 switches/min to 2.5 switches/min (P < .001), and time spent in backup ventilation increased from 2%/min to 9%/min (P < .001). However, clinically significant events decreased from 7 clinically significant events per hour to 2 clinically significant events per hour (P < .001). Measured breathing frequency increased with the 2-s apnea time but spontaneous breathing frequency, FIO 2, peak and minimum electrical activity of the diaphragm, and peak pressure remained unchanged.


Short apnea times resulted in more switches into backup ventilation and longer time in backup ventilation but promoted clinical stability with fewer clinically significant events in neonates ventilated with NIV-NAVA.


NAVA; apnea; neonatology; neurally adjusted ventilatory assist; triggering


Conflict of interest statement

Dr Stein and Ms Firestone have disclosed relationships with Getinge. Drs Morgan and Schachinger have disclosed no conflicts of interest.

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