Successful Use of Neurally Adjusted Ventilatory Assist in Managing Refractory Bilateral Pneumatoceles in a Premature Neonate

Background: Pneumatoceles are air-filled cystic lesions within the lung parenchyma, often arising from severe pneumonia or mechanical ventilation-induced lung injury, which pose significant risk, particularly in neonates requiring high positive-pressure ventilation. Traditional management includes conservative monitoring, percutaneous drainage, and/or surgical intervention. High-frequency ventilation is frequently employed to minimize barotrauma. Case Summary: We present a neonate born at 290/7 weeks of gestation, weighing 780 grams. Post-delivery, the patient developed pneumonia, leading to multiple refractory bilateral pneumatoceles and transfer to our hospital. Initial management included high frequency jet ventilation and inhaled nitric oxide, with limited improvement over three weeks, after which we initiated Neurally Adjusted Ventilatory Assist (NAVA), leading to significant clinical improvement. Radiographic imaging showed rapid improvement of the pneumatoceles on NAVA, with complete resolution observed at outpatient follow-up. Discussion: This case demonstrates successful management of refractory bilateral pneumatoceles using NAVA. It's patient-driven approach provides synchronized, gentle ventilation, crucial for treating pulmonary air leak syndromes and facilitating natural weaning. NAVA’s dynamic adjustments and ability to closely match ventilatory support to the patient's neural respiratory drive using less peak inspiratory pressure offers a promising strategy for managing complex pulmonary conditions, such as pneumatoceles, in neonates.