Neurally Adjusted Ventilatory Assist Compared with Volume-Targeted and Pressure-Controlled Modes in Preterm Infants with Respiratory Distress Syndrome

<b>Background/Objectives</b>: Preterm infants with respiratory distress syndrome (RDS) require mechanical ventilation but risk lung injury This study compared neurally adjusted ventilatory assist (NAVA) with conventional modes regarding respiratory mechanics and clinical outcomes. <b>Methods</b>: We analyzed data from 79 preterm infants born at <32 weeks gestation who were invasively ventilated for RDS and classified into three groups: NAVA (n = 26), volume-targeted (VT; n = 29), and pressure-controlled (PC; n = 24). Respiratory parameters for 6 h post-surfactant administration and clinical outcomes were evaluated. <b>Results</b>: Baseline characteristics were similar across groups. The NAVA group demonstrated the most rapid reduction in peak inspiratory pressure over 6 h (F = 4.125, <i>p</i> = 0.023) and the fastest increase in dynamic compliance during the first 4 h (F = 3.273, <i>p</i> = 0.048). Respiratory rates were significantly lower with NAVA than with VT or PC modes, while tidal volumes were significantly higher in PC than in NAVA or VT modes. Invasive mechanical ventilation duration was shorter in NAVA (3.0 [0.9-4.9] days) than in PC modes (15.1 [0.3-38.5] days, <i>p</i> = 0.031), whereas not significantly different from that in VT modes (3.8 [0.9-13.4] days). While bronchopulmonary dysplasia or death was lower in NAVA (19.2%) than in PC modes (41.7%), the difference was not statistically significant (<i>p</i> = 0.092). <b>Conclusions</b>: NAVA resulted in the fastest reduction in ventilator-delivered pressure and earlier improvement in dynamic compliance while maintaining respiratory rates within physiological ranges and was associated with shorter ventilation duration than PC modes. However, VT modes achieved comparable respiratory parameters and ventilation durations to those achieved using NAVA.