The using of a neurally adjusted ventilatory assist in premature infants. Article

Abstract

Introduction. The problem of choosing an adequate mode and parameters of mechanical ventilation (MV) in premature infants remains extremely important in neonatology. Objectives. To assess the effect of nerve-regulated MV on the gas composition of the blood, the concentration of malondialdehyde (MDA) and glutathione in premature infants. Materials and methods. The study included 46 premature infants who underwent MV from birth. The gestational age of children was 25–32 weeks, birth weight — 520–1100 grams. Two study groups were formed. The first group consisted of newborns with respiratory support in the Synchronized Intermittent Mandatory Ventilation (SIMV), the second group consisted of children who underwent Neurally Adjusted Ventilatory Assist (NAVA).At birth and during the first three days, the parameters of the gas composition of venous blood are measured: pH, pCO2, pO2, BE; lactate level. Concentrations of MDA and glutathione determine the first and seventh days of life. Results. In children of the first group, hypocapnia was observed during the first three days of life, while the minimum level of partial pressure of carbon dioxide (pCO2) was observed on the first day and amounted to 32.0 (24.9; 37.8) mm Hg. In patients of the second group, pCO2 indices were close to the reference ones and amounted to 36.0 (32.5; 42.2) mm Hg (p = 0.01).Indicators of excess base (BE) were reduced in patients in both groups and on the third day amounted to −6.4 (−7.4;−5.2) mmol/l in children of the first group and −4.7 (−6.0;−3.1) mmol/l in children of the second group (p = 0.02). No statistically significant differences in the partial pressure of oxygen (pO2), lactate, and glutathione were observed. Values of MDA were increased in patients of the first and second groups, however, a decrease in its concentration was observed in the dynamics in both groups. On the 7th day, in patients of the first group, the concentration of malondialdehyde decreased from 13.4 nmol/l to 12.0 nmol/l. In patients of the second group, its indices decreased twofold from the initial ones and amounted to 6.3 (5.4; 7.4) nmol/l (p = 0.01). Conclusion.The use of NAVA ventilation in premature infants ensures a constant gas composition of the blood, and also prevents the activation of lipid peroxidation resulting from hypoxia.