RT Journal Article
SR Electronic
T1 Diaphragm electrical activity during weaning of nasal high-flow therapy in preterm infants
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP fetalneonatal-2022-324112
DO 10.1136/archdischild-2022-324112
A1 Rebecca Naples
A1 Alan C Fenton
A1 Malcolm Brodlie
A1 Sundeep Harigopal
A1 Chris O'Brien
YR 2022
UL http://fn.bmj.com/content/early/2022/10/12/archdischild-2022-324112.abstract
AB Objective To determine whether electrical activity of the diaphragm (Edi) changes with weaning nasal high-flow (HF) therapy in preterm infants according to a standardised protocol.Design Prospective observational cohort study.Setting Neonatal intensive care unit.Patients Preterm infants born at <32 weeks gestation, receiving nasal HF as part of routine clinical care.Interventions Infants recruited to the study had their HF weaned according to set clinical criteria. Edi was measured using a modified gastric feeding tube serially from baseline (pre-wean) to 24-hours post-wean.Main outcome measures Change in Edi from baseline was measured at four time points up to 24 hours after weaning. Minimum Edi during expiration, maximum Edi during inspiration and amplitude of the Edi signal (Edidelta) were measured. Clinical parameters (heart rate, respiratory rate and fraction of inspired oxygen) were also recorded.Results Forty preterm infants were recruited at a mean corrected gestational age of 31.6 (±2.7) weeks. Data from 156 weaning steps were analysed, 91% of which were successful. Edi did not change significantly from baseline during flow reduction steps, but a significant increase in diaphragm activity was observed when discontinuing HF (median increase in Edidelta immediately post-discontinuation 1.7 µV (95% CI: 0.6 to 3.0)) and at 24 hours 1.9 µV (95% CI: 0.7 to 3.8)). No significant difference in diaphragm activity was observed between successful and unsuccessful weaning steps.Conclusions A protocolised approach to weaning has a high probability of success. Edi does not change with reducing HF rate, but significantly increases with discontinuation of HF from 2 L/min.All data relevant to the study are included in the article or uploaded as supplemental information.