{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:16:54Z","timestamp":1788959814234,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives And Hypothesis<\/jats:title>\n                    <jats:p>Tonic diaphragmatic activity is common during non\u2010invasive ventilation (NIV), suggesting efforts to increase end\u2010expiratory lung volume. We assessed the feasibility and physiological impact of NeuroPAP, a novel NIV mode continuously adjusting the delivered positive pressure proportionally to diaphragm electric activity (Edi) during both inspiration and expiration, in infants with respiratory failure. We hypothesized NeuroPAP would enable dynamic control of end\u2010expiratory pressures (PEEP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>This prospective crossover study enrolled premature neonates (25\u201334 weeks) and infants with bronchiolitis supported by NIV\u2010NAVA. Subjects underwent three ventilation phases: NIV\u2010NAVA, NeuroPAP, and repeat NIV\u2010NAVA. Ventilation pressures, Edi, cardio\u2010respiratory events, neural breathing patterns, and systemic and cerebral oxygenation were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 15 infants with bronchiolitis and 8 premature neonates were included. The overall median PEEP was unchanged between modes, but PEEP was actively adjusted, with increased breath\u2010to\u2010breath variability of PEEP in NeuroPAP (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Compared to pre\u2010study settings, individual PEEP increased in NeuroPAP in 7, decreased in 9, and was unchanged in 7 patients. In NeuroPAP, the breathing pattern was phasic 74% of the time and tonic 16% of the time, compared to 61% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.31) and 23% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.36) in NIV\u2010NAVA. Respiratory rate was lower in NeuroPAP in the neonates (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). The estimated PaO\n                      <jats:sub>2<\/jats:sub>\n                      \/FiO\n                      <jats:sub>2<\/jats:sub>\n                      ratio was higher in the post\u2010NeuroPAP NIV\u2010NAVA period in the bronchiolitis group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). Edi, heart rate, cerebral NIRS, or cardio\u2010respiratory events were unchanged.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In infants with respiratory failure, NeuroPAP allowed dynamic control and personalization of PEEP. The clinical impact of this warrants further evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.71434","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T05:31:38Z","timestamp":1767072698000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A physiologic Comparison of Continuous Neurally Adjusted Ventilation (NeuroPAP) Versus Neurally\u2010Adjusted Ventilatory Assist (NAVA) in Infants With Respiratory Failure"],"prefix":"10.1002","volume":"61","author":[{"given":"Virginie","family":"Plante","sequence":"first","affiliation":[{"name":"Division of Pediatric Intensive Care, Department of Pediatrics, Sainte\u2010Justine Hospital Universit\u00e9 de Montreal Montreal Quebec Canada"},{"name":"Division of Pediatric Intensive Care, Department of Pediatrics University of Sherbrooke  Quebec 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