{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:12:48Z","timestamp":1787731968905,"version":"build-2784847793"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"KMRT\/KCHC PhD studentship"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Retrospective studies comparing NAVA to assist control ventilation (ACV) in neonates with congenital diaphragmatic hernia (CDH) have shown that ventilatory mode may improve respiratory parameters. The aim of this study is to determine if infants with CDH studied post-operatively had a lower oxygenation index (OI) on NAVA compared to ACV. This dual-centre randomised cross-over trial compared post-operative NAVA with ACV in infants with CDH. Infants were randomised to receive either NAVA or ACV first in a 1:1 ratio for a 4-h period. At the end of each 4-h period, blood gas analysis was performed and the OI calculated. The inspired oxygen concentration (FiO\n                    <jats:sub>2<\/jats:sub>\n                    ), the peak inflation (PIP), and mean airway pressure (MAP) were averaged from the last 5\u00a0min on each mode. Eleven infants were randomised. Nine infants completed the trial\n                    <jats:bold>.<\/jats:bold>\n                    with median gestational age of 38 (range 34.6\u201339.3) weeks and median postnatal age of 7 (range 5\u201336) days. Eight had left-sided CDH, six had patch repair and two had thoracoscopic repair. The mean OI after 4\u00a0h on NAVA was 3.9\u2009\u00b1\u20091.8 compared to 5.9\u2009\u00b1\u20091.61 on ACV (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.008). The peak Edi (6.05\u2009\u00b1\u20094.5 versus 9.86\u2009\u00b1\u20097.3\u00a0\u00b5V,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.028), PIP (17\u2009\u00b1\u20096.3 versus 22\u2009\u00b1\u20095.3 cmH\n                    <jats:sub>2<\/jats:sub>\n                    O,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.017), and MAP (8.7\u2009\u00b1\u20092.6 versus 11.1\u2009\u00b1\u20091.8 cmH\n                    <jats:sub>2<\/jats:sub>\n                    O,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.008), expiratory tidal volume (5.06\u2009\u00b1\u20090.71 versus 9.86\u2009\u00b1\u20091.29 ml\/kg,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.043) were lower on NAVA versus ACV. Two infants were randomised, but the trial was stopped due to a low Edi signal.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    :\u00a0NAVA compared to ACV improved oxygenation postoperatively in infants with CDH. On NAVA, infants had lower oxygen indices, peak Edi, expiratory tidal volume and peak and mean airway pressures.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Neonates with congenital diaphragmatic hernia (CDH) require mechanical ventilation, but the optimal ventilatory strategy to minimise ventilator-induced lung injury remains unclear<\/jats:italic>\n                              .\u2022\n                              <jats:italic>Retrospective studies suggest that neurally adjusted ventilatory assist (NAVA) is feasible in CDH and may reduce ventilatory pressures and improve respiratory parameters<\/jats:italic>\n                              .\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is new:<\/jats:bold>\n                              \u2022\n                              <jats:italic>This is the first prospective randomised crossover trial comparing NAVA with assist-control ventilation in postoperative neonates with CDH<\/jats:italic>\n                              .\u2022\n                              <jats:italic>NAVA significantly improved oxygenation (lower OI) and reduced peak and mean airway pressures, supporting more efficient ventilation at lower pressures.<\/jats:italic>\n                              .\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-06888-5","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T03:45:24Z","timestamp":1775706324000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Randomised crossover trial of neurally adjusted ventilatory assist (NAVA) for neonates with congenital diaphragmatic hernias: the NAN-C study"],"prefix":"10.1007","volume":"185","author":[{"given":"Sandeep","family":"Shetty","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Jenkinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Poole","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Dassios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anay","family":"Kulkarni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donovan","family":"Duffy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Greenough","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"issue":"1","key":"6888_CR1","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1159\/000444210","volume":"110","author":"KG Snoek","year":"2016","unstructured":"Snoek KG, Reiss IK, Greenough A et al (2016) Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO consortium consensus - 2015 update. 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Arch Dis Child 63(7 Spec No):743\u2013747","journal-title":"Arch Dis Child"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-06888-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-026-06888-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-06888-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T06:01:54Z","timestamp":1780120914000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-026-06888-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":22,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["6888"],"URL":"https:\/\/doi.org\/10.1007\/s00431-026-06888-5","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-8703181\/v1","asserted-by":"object"}]},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]},"assertion":[{"value":"26 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 March 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The NAN-C study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the West of Scotland Research Ethics Committee (REC; reference number 23\/WS\/0070).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Infants whose parents gave informed written consent were recruited.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Dr Shetty was previously a member of the Medical Advisory Board for Maquet Critical Care AB and has received honoraria from Getinge for speaking at webinars and conferences. Professor Greenough has held grants and honoraria for lecturing from ventilator companies. They were not involved in the study design, data collection, data analysis or production of the manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"246"}}