Background and aims Invasive and non-invasive ventilation of the neonate may be associated with local and systemic complications due to mechanical trauma to lung tissues and their inflammatory response. A key objective of mechanical ventilation is to reduce its duration and side effects. Neurally Adjusted Ventilatory Assist (NAVA), a method that uses the electrical activity of the diaphragm (EAdi) as a signal to trigger the mechanical ventilatory breaths, may improve synchronisation between patient and ventilator and optimise the gas volume delivered to the lungs, according to the patient needs, eventually reducing volu- and biotrauma. We aimed to test the effectiveness of NAVA in the neonate.

Methods We present three preterm babies with severe respiratory distress syndrome that failed several attempts of weaning and extubation, and two full-term new-borns with amniotic fluid aspiration that could be successfully managed after changing from conventional ventilation to NAVA.

Results Our most frequent observations were a reduction in the Peak Inspiratory Pressure and in the need of FiO₂, after changing from S-IMV, A/C or Pressure Regulated Volume Control to NAVA. We also observed a reduction in respiratory rate and an increase in the patients’ comfort. After extubation, during NIV-NAVA, the patients remained stable and confortable, even with the presence of air-leaks up to 90%. No patient required reintubation.

Conclusions NAVA is effective in weaning and extubation of neonates and seems to provide more comfort to the patients. Further studies are needed to assess whether short-term benefits are reflected in better outcomes in the long run.