• NAVA
• paralysis
• diaphragm
• neonate
• cardiac surgery

There are presently only scant data published about neonatal diaphragmatic paralysis and the options for its clinical management. We observed a case of unilateral diaphragmatic paralysis secondary to thoracic surgery in a preterm neonate, and we successfully managed it using neurally adjusted ventilator assist (NAVA) whose data have been electronically recorded in real time. Parents gave written consent for publication.

A preterm female baby, born at 25 weeks’ gestation, was diagnosed with haemodynamically patent ductus arteriosus, which needed surgical closure since two cures of ibuprofen failed to close it. After the surgery, she could not be weaned from mechanical ventilation for 26 days; chest X-rays revealed elevation of the left hemidiaphragm and targeted ultrasound confirmed the hemidiaphragmatic paralysis. The patient was shifted to invasive NAVA with Servo-i (Maquet, Solna, Sweden) and then finally extubated on biphasic positive airway pressure ventilation (BiPAP) through a nasal mask, as this is our routine clinical protocol. The NAVA level used was set at 4 cmH₂O/μV and gradually decreased to 1 by steps of 0.5 cmH_{2 …}