{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:47:31Z","timestamp":1792414051723,"version":"4.4.0"},"reference-count":16,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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":[[2026,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Neurally adjusted ventilatory assist (NAVA) delivers ventilatory support proportional to diaphragmatic electrical activity, improving patient\u2013ventilator synchrony. Its effects on lung aeration and diaphragmatic workload in extremely preterm infants have not been well characterized.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n We hypothesized that initiation of NAVA in preterm infants born at <\u200932 weeks' gestation would result in improved lung recruitment while allowing effective ventilation at lower airway pressures without increasing diaphragmatic workload.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This prospective observational pilot study was conducted in a tertiary neonatal intensive care unit. Nineteen preterm infants (median gestational age 24\u2009+\u20095 weeks; median birth weight 700\u2009g, range 380\u20131352\u2009g) were transitioned to NAVA at a median postnatal age of 30\u2009+\u20095 days according to a pre\u2010specified unit protocol. Lung ultrasound aeration scores (LUS), diaphragmatic excursion and thickness, peak electrical diaphragmatic activity (EAdi peak), mean airway pressure (MAP), and FiO\n 2<\/jats:sub>\n were measured immediately before and 1 h after NAVA initiation. Paired statistical analyses were performed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n LUS decreased markedly following NAVA initiation (mean 15.21\u2009\u00b1\u20093.26 vs. 7.11\u2009\u00b1\u20092.47;\n p<\/jats:italic>\n \u2009<\u20090.001; Cohen's d\u2009=\u20093.02), with the effect observed in both invasive and non\u2010invasive NAVA groups. MAP decreased significantly (11.82\u2009\u00b1\u20091.63 vs. 9.56\u2009\u00b1\u20091.64 cmH\n 2<\/jats:sub>\n O;\n p<\/jats:italic>\n \u2009<\u20090.001) and FiO\n 2<\/jats:sub>\n showed a non\u2010significant trend towards improvement (0.35 vs. 0.32;\n p<\/jats:italic>\n \u2009=\u20090.020). Diaphragmatic excursion (7.05\u2009\u00b1\u20092.1 vs. 6.7\u2009\u00b1\u20092.2\u2009mm;\n p<\/jats:italic>\n \u2009=\u20090.650) and EAdi peak (8.4 vs. 8.3\u2009mV;\n p<\/jats:italic>\n \u2009=\u20090.839) were unchanged.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this pilot cohort, initiation of NAVA in extremely preterm infants was associated with rapid improvement in lung ultrasound aeration scores and reduced ventilatory pressures, without evidence of increased diaphragmatic loading. These findings are hypothesis\u2010generating and larger controlled studies are needed to confirm them.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ppul.71885","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:27:32Z","timestamp":1792412852000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Neurally Adjusted Ventilatory Assist on Lung Ultrasound Aeration and Diaphragmatic Function in Extremely Preterm Infants With Evolving or Established Bronchopulmonary Dysplasia"],"prefix":"10.1002","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1946-2486","authenticated-orcid":false,"given":"Anay","family":"Kulkarni","sequence":"first","affiliation":[{"name":"Neonatal Intensive Care Centre, St George's University Hospitals NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Richards","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Centre, St George's University Hospitals NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7972-9623","authenticated-orcid":false,"given":"Touqueer","family":"Fatima","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Centre, St George's University Hospitals NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shavindra","family":"Chellen","sequence":"additional","affiliation":[{"name":"Department of Neonatology, William Harvey Hospital East Kent Hospitals University NHS Foundation Trust Ashford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donovan","family":"Duffy","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Centre, St George's University Hospitals NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7390-5228","authenticated-orcid":false,"given":"Sandeep","family":"Shetty","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Centre, St George's University Hospitals NHS Foundation Trust London UK"},{"name":"City St George's University of London London UK"},{"name":"Faculty of Life Sciences and Medicine, King's College London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1164\/ajrccm.163.7.2011060","article-title":"Bronchopulmonary Dysplasia","volume":"163","author":"Jobe A. H.","year":"2001","journal-title":"American Journal of Respiratory and Critical Care Medicine"},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.siny.2009.08.002","article-title":"Prevention of Bronchopulmonary Dysplasia","volume":"14","author":"Laughon M. M.","year":"2009","journal-title":"Seminars in Fetal and Neonatal Medicine"},{"key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1203\/PDR.0b013e31819e72ab","article-title":"Patient\u2013Ventilator Interaction During Neurally Adjusted Ventilatory Assist in Low Birth Weight Infants","volume":"65","author":"Beck J.","year":"2009","journal-title":"Pediatric Research"},{"key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.siny.2013.09.005","article-title":"Application of Neurally Adjusted Ventilatory Assist in Neonates","volume":"19","author":"Stein H.","year":"2014","journal-title":"Seminars in Fetal and Neonatal Medicine"},{"key":"e_1_2_12_6_1","first-page":"e76","article-title":"Randomized Crossover Study of Nava in Preterm Infants","volume":"130","author":"Lee J.","year":"2012","journal-title":"Pediatrics"},{"key":"e_1_2_12_7_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamapediatrics.2015.1797","article-title":"Lung Ultrasonography Score to Evaluate Oxygenation and Surfactant Need in Neonates Treated With Continuous Positive Airway Pressure","volume":"169","author":"Brat R.","year":"2015","journal-title":"JAMA Pediatrics"},{"key":"e_1_2_12_8_1","doi-asserted-by":"crossref","DOI":"10.1186\/cc11865","article-title":"Can Neonatal Lung Ultrasound Monitor Fluid Clearance and Predict the Need of Respiratory Support?","volume":"16","author":"Raimondi F.","year":"2012","journal-title":"Critical Care"},{"key":"e_1_2_12_9_1","first-page":"1141","article-title":"Lung Ultrasound Score Predicts Bronchopulmonary Dysplasia","volume":"53","author":"De Martino L.","year":"2018","journal-title":"Pediatric Pulmonology"},{"key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1007\/s00134-015-3687-3","article-title":"Measuring Diaphragm Thickness With Ultrasound in Mechanically Ventilated Patients: Feasibility, Reproducibility and Validity","volume":"41","author":"Goligher E. C.","year":"2015","journal-title":"Intensive Care Medicine"},{"key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1055\/s-0037-1608682","article-title":"Comparative Study of the Effects of Continuous Positive Airway Pressure and Nasal High\u2010Flow Therapy on Diaphragmatic Dimensions in Preterm Infants","volume":"35","author":"El\u2010Mogy M.","year":"2018","journal-title":"American Journal of Perinatology"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-020-03805-2"},{"key":"e_1_2_12_13_1","first-page":"332","article-title":"Electrical Activity of the Diaphragm During Nava in Preterm Infants","volume":"109","author":"Kallio M.","year":"2016","journal-title":"Neonatology"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2025.09.119"},{"key":"e_1_2_12_15_1","first-page":"220","article-title":"Diaphragm Electrical Activity During Assisted Ventilation","volume":"189","author":"Emeriaud G.","year":"2014","journal-title":"American Journal of Respiratory and Critical Care Medicine"},{"key":"e_1_2_12_16_1","first-page":"573","article-title":"Respiratory Muscle Fatigue","volume":"131","author":"Hussain S. N.","year":"1985","journal-title":"American Review of Respiratory Disease"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-022-04738-8"}],"container-title":["Pediatric Pulmonology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.71885","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ppul.71885","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.71885","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:27:34Z","timestamp":1792412854000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ppul.71885"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":16,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/ppul.71885"],"URL":"https:\/\/doi.org\/10.1002\/ppul.71885","archive":["Portico"],"relation":{},"ISSN":["8755-6863","1099-0496"],"issn-type":[{"value":"8755-6863","type":"print"},{"value":"1099-0496","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-05-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71885"}}