A cutting-edge breathing support strategy called NAVA monitors a baby’s breathing by sensing the electrical potential of the diaphragm. It ensures adequate oxygenation of the patient without excessive effort. The Perinatology Centre at the Brno University Hospital is the only facility in the Czech Republic to use this unique method, even for extremely premature newborns who have prolonged breathing difficulties and are dependent on breathing support for long weeks. Photo credit: FN Brno

Brno, July 20 (BD) – At the neonatal intensive care unit at Brno University Hospital, around 50 extremely premature newborns are treated every year. Most of them require care for three months or longer. This care is very demanding in terms of the capabilities of the attending staff, instrumentation and material equipment, constant and patient involvement of parents and their recruitment for this care.

The NAVA (Neurally-adjusted ventilatory assist) method is a completely new strategy of breathing support that uses electrical potential sensing from the diaphragm, the main respiratory muscle, to monitor the patient’s breathing activity. The respiratory software evaluates this electrical signal 60 times per second and transfers it to a near-perfectly synchronous breathing support, whose rate is adjusted to ensure the young patient receives enough oxygen without more exertion than is sustainable. Each person’s spontaneous breathing is controlled by the respiratory centre in the brain stem, and this method of breathing support is entirely based on one’s own breathing activity. This makes it possible to eliminate the use of some drugs that are currently in use, which improve respiratory function but have adverse effects. Overall, it is all about improving the respiratory comfort of newborn patients and providing better prospects for future development.

“All extremely premature newborns have prolonged breathing difficulties and are referred for respiratory support for long weeks. Although efforts are made to provide non-invasive methods of support as the method of choice for these newborns, their breathing difficulties frequently escalate to the point that they are referred to an invasive method of supportive breathing. This helps get adequate oxygen to their blood, but the high intensity of breathing support can damage the lungs and adversely affect the healing processes taking place there. The NAVA method is almost completely synchronous with spontaneous breathing activity and appears to be lung-friendly in both forms. The non-invasive form then helps to delay or even completely prevent respiratory failure. From our experience so far, we can already see that the NAVA method is very well tolerated, and that stabilization and improvement of respiratory functions occurs immediately after its initiation,” said Dr. Zuzana Zavřelová, from the neonatal ICU of Brno University Hospital.

This method of breathing support is about 20 years old and its clinical use has been made possible by the rapid development of information technology in recent years. Brno University Hospital has been using it since 2020 and is thus the only perinatology center in the Czech Republic. In the world, this method has been increasingly promoted in neonatal intensive care in the United States, in developed East Asian countries, in Europe, mainly in Scandinavia, but there is also good experience with it in neighboring Austria. In addition to newborns, it is also suitable for pediatrics and adult patients.

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