​Newborn infants may need respiratory support due to respiratory distress syndrome or other pulmonary reasons. Breathing can be supported invasively with ventilator treatment or non-invasively with synchronized ventilation (NIV NAVA), nasal continuous positive airway pressure (nCPAP) or high-flow nasal cannula (HFNC). NAVA (Neurally Adjusted Ventilatory Assist) ventilation is a new ventilation mode which utilizes the diaphragm electrical signal (EAdi signal) as a neural trigger to synchronize ventilator breaths with the infant's neural respiratory drive. Further, the support is given proportionally for each single breath according to the magnitude of the EAdi signal.

The need for respiratory support may last for weeks especially with prematurely born infants. Optimizing respiratory care is important not only to lessen the work of breathing but also to enhance growth and to minimize adverse effects on the lung and brain development.

​The Baby Friendly Ventilation Study group from the Turku University Hospital has organized international NAVA workshops since year 2014. The two-day workshop includes lectures, patient cases and bed-side teaching in the NICU at Turku University Hospital as well as educational patient cases presented by the participants. We have had participants from all over the world including Japan, South Korea, China, Australia, Croatia, Belgium, Norway, Sweden, Denmark, Estonia and Finland. The feedback from the workshop has been excellent.

You can request about the next workshop from hanna.soukka(a)utu.fi or NAVA(a)tyks.fi

Example of course schedule:

NAVA workshop invitation letter and preliminary program 2022

The objective of the Baby Friendly Ventilation Study group is to study different respiratory support modes in order to optimize the given support. The study group operates at the NICU of the Turku University Hospital. The main topics of our research are:

• Control of breathing
• Work of breathing during different respiratory support modes
• The effect of different ventilator modes on infant's physiology
• The effect of different medications on breathing
• The effect of the implementation of NAVA ventilation on different clinical outcomes

The respiratory centre in the brainstem controls breathing by sending an impulse to the diaphragm via the phrenic nerve to activate the diaphragm. NAVA ventilation is based on the continuous measurement of this electrical activity with a special nasogastric tube (EAdi catheter) including miniature electrodes. The EAdi signal is amplified, digitalized and filtered and transmitted to the ventilator. The signal is then used as a neural trigger for each breath resulting in better synchrony between the patient and the ventilator. In NAVA ventilation, the patient also controls the respiratory frequency, inspiratory time, inspiratory pressure and the termination of breath.

The Baby Friendly Ventilation Study Group:

Vilhelmiina Parikka, MD, PhD, neonatologist
Arata Oda, MD, neonatologist
Heli Mäntylä, neonatal nurse
Hanna Soukka MD, Docent, neonatologist
Liisa Lehtonen MD, Professor in Pediatrics, neonatologist
Juyoung Lee MD, Professor in Pediatrics, neonatologist
Katarzyna Piątek, MD, Research fellow

Publications

Soukka H, Lehtonen L. Clinical Protocol: Neonatal ICU, Neurally Adjusted Ventilatory Assist, NAVA. Critical Care News 2013.

Soukka H, Grönlund L, Leppäsalo J, Lehtonen L. The effects of skin-to-skin care on the diaphragmatic electrical activity in preterm infants. Early Hum Dev 2014; 90(9): 531-534.

Soukka H, Parikka V, Lehtonen L. Kokemuksia NAVA-hoidosta Tyksin vastasyntyneiden teho-osastolla. Finnanest 2015; 48(3): 239-241.

Parikka V, Beck J, Zhai Q, Leppäsalo J, Lehtonen L, Soukka H. The Effect of Caffeine Citrate on Neural Breathing Pattern in Preterm Infants. Early Hum Dev 2015; 91: 565-568.

Soukka H, Grönlund L, Leppäsalo J, Lehtonen L. The effects of skin-to-skin care on the diaphragmatic electrical activity in preterm infants. Early Hum Dev 2014; 90(9): 531-534. (2.122)

Parikka V, Beck J, Zhai Q, Leppäsalo J, Lehtonen L, Soukka H. The Effect of Caffeine Citrate on Neural Breathing Pattern in Preterm Infants. Early Hum Dev 2015; 91: 565-568. (2.122)

Oda A, Parikka V, Lehtonen L, Soukka H. Rapid respiratory transition at birth as evaluated by electrical activity of the diaphragm in very preterm infants supported by nasal CPAP. Respiratory Physiology & Neurobiology 2018, 254: 1-4 https://doi.org/10.1016/j.resp.2018.09.009

Oda A, Lehtonen L, Soukka H. Neurally adjusted respiratory support can be used to wean infants with congenital diaphragmatic hernias off respiratory support. Acta Paediatr 2018; 107(4): 718-9.

Oda A, Parikka V, Lehtonen L, Porres I, Soukka H. Nasal high flow therapy decreased electrical activity of the diaphragm in preterm infants during the weaning phase. Acta Paediatr 2019 Feb;108(2):253-257. doi: 10.1111/apa.14485. Epub 2018 Jul 25.

Soukka H, Parkkola R, Lehtonen L. Brain growth in extremely preterm infants before and after implementing NAVA ventilation. Acta Paediatr 2021; 00: 1-3. https://doi.org/10.1111/apa.15749

Lee J, Parikka V, Lehtonen L, Soukka H. Backup ventilation during neurally adjusted ventilatory assist in preterm infants. Pediatr Pulmonol. 2021 Jul 26. doi: 10.1002/ppul.25583. Online ahead of print.

Lee J, Parikka V, Lehtonen L, Soukka H. Parent-infant skin-to-skin contact reduces the electrical activity of the diaphragm and stabilizes respiratory function in preterm infants. Pediatr Res. 2021 Jun 4:1-5. doi: 10.1038/s41390-021-01607-2. Online ahead of print.

Oda A, Parikka V, Lehtonen L, Azimi S, Porres I, Soukka H. Neurally adjusted ventilatory assist in ventilated very preterm infants: a crossover study. Pediatr Pulmonol 2021 Aug 26. doi: 10.1002/ppul.25639. Online ahead of print.

Piatek K, Lehtonen L, Parikka V, Setänen S, Soukka H. Implementation of neurally adjusted ventilatory assist and high flow nasal cannula in very preterm infants in a tertiary level NICU. Pediatr Pulmonol 2022.