nCPAP-NAVA-Backup Versus Standard nCPAP for Severe Apnea in Preterm Infants ≤28 Weeks (NAVAPNEA)
Effect of nCPAP-NAVA-backup Mode Versus Standard nCPAP Mode on the Reduction of Severe Apnea in Preterm Infants ≤ 28 Weeks - a Crossover Trial
The goal of this clinical trial is to determine whether nasal continuous positive airway pressure (nCPAP) with neurally adjusted ventilatory assist (NAVA) backup ventilation (nCPAP-NAVA-backup mode) reduces the rate of severe apnea in extremely preterm infants ≤28 weeks' gestation compared with standard nasal continuous positive airway pressure (nCPAP mode). Severe apnea episodes is defined as breathing pause with oxygen levels ( SpO2) below 85% lasting at least 5 seconds and/or heart rate (HR) below 100 beats/minute lasting at least 5 seconds.
Each participant will receive both interventions in a randomized order, serving as their own control. The total duration of the intervention will be 24h. Each intervention period will last 12 hours. A washout period of 3 hours will be included between intervention periods to minimize potential carryover effects.
Randomized sequences to avoid order effects:
- Sequence A: nCPAP mode → nCPAP-NAVA-backup mode
- Sequence B: nCPAP-NAVA-backup mode →nCPAP mode
Descripción general del estudio
Estado
Estado
Condiciones
Condiciones
Intervención / Tratamiento
Intervención / Tratamiento
Tipo de estudio
Tipo de estudio
Inscripción (Estimado)
Inscripción
Fase
Fase
- No aplica
Contactos y Ubicaciones
Ubicaciones de estudio
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Geneva, Suiza
- University hospital of Geneva
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Contacto:
- Dimitra Papasavva
- Correo electrónico: dimitra.papasavva@hug.ch
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Criterios de participación
Criterio de elegibilidad
Criterio de elegibilidad
Edades elegibles para estudiar
- Niño
- Adulto
- Adulto Mayor
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria:
- Born at ≤28 weeks gestational age
- Currently receiving nCPAP mode as part of routine care
- Receiving caffeine citrate at a maintenance dose of 10 mg/kg/day
- An average of ≥1 severe apnea per hour over a 6-hour period (apnea associated with SpO₂<85% during ≥ 5 seconds and/or HR <100 bpm during ≥ 5 seconds) or an average of >2 severe apnea per hour over a 2-hour period
- Written informed consent obtained from the legal representatives before inclusion.
Exclusion Criteria:
- Major congenital anomalies (e.g., congenital diaphragmatic hernia, significant cardiac malformations)
- Known genetic syndrome affecting respiratory function
- Immediate indication for endotracheal intubation or noninvasive ventilation (NIV)
- Parental refusal or withdrawal of consent
- Previous inclusion in the study
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación cruzada
- Enmascaramiento: Ninguno (etiqueta abierta)
Número de brazos
Armas e Intervenciones
Grupo de participantes/brazoGrupo de participantes/brazo |
Intervención / TratamientoIntervención / Tratamiento |
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Experimental: Sequence A: nCPAP then nCPAP-NAVA-Backup
Preterm infants randomized to receive 12 hours of standard nCPAP mode followed by 12 hours of nCPAP-NAVA-backup mode (total 24 hours) on a Servo-n ventilator. A 3-hour washout period at the start of each period is excluded from analysis. |
Standard nasal CPAP delivered via a Servo-n ventilator, with continuous monitoring of the electrical activity of the diaphragm (Edi) through an Edi catheter that also serves as the feeding tube. When an apnea exceeds the preset apnea time, pressure-controlled backup ventilation is triggered automatically. Backup and PEEP settings follow unit standards, and PEEP is kept constant throughout the study. Duration: 12 hours. Standard nasal CPAP delivered via nasal prongs or mask on the same Servo-n ventilator and circuit, with PEEP and FiO₂ managed according to standard clinical practice. Duration: 12 hours. |
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Experimental: Sequence B: nCPAP-NAVA-backup then nCPAP
Preterm infants randomized to receive 12 hours of nCPAP-NAVA-backup mode followed by 12 hours of standard nCPAP mode (total 24 hours) on a Servo-n ventilator. A 3-hour washout period at the start of each period is excluded from analysis. |
Standard nasal CPAP delivered via a Servo-n ventilator, with continuous monitoring of the electrical activity of the diaphragm (Edi) through an Edi catheter that also serves as the feeding tube. When an apnea exceeds the preset apnea time, pressure-controlled backup ventilation is triggered automatically. Backup and PEEP settings follow unit standards, and PEEP is kept constant throughout the study. Duration: 12 hours. Standard nasal CPAP delivered via nasal prongs or mask on the same Servo-n ventilator and circuit, with PEEP and FiO₂ managed according to standard clinical practice. Duration: 12 hours. |
¿Qué mide el estudio?
Medidas de resultado primarias
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Number of severe apnea episodes per 9-hour observation period
Periodo de tiempo: Per 9-hour observation period
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Number of severe apnea episodes per 9-hour observation period, defined as an apnea associated with oxygen desaturation (SpO₂ < 85%) lasting ≥ 5 seconds and/or bradycardia (Heart rate (HR) < 100 bpm) lasting ≥ 5 seconds |
Per 9-hour observation period
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Medidas de resultado secundarias
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Number of isolated oxygen desaturation episodes
Periodo de tiempo: Per 9-hour observation period
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SpO₂ < 85% for ≥ 5 seconds, not associated with a severe apnea episode |
Per 9-hour observation period
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Number of isolated bradycardia episodes
Periodo de tiempo: per 9-hour observation period
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HR < 100 bpm for ≥ 5 seconds, not associated with a severe apnea episode |
per 9-hour observation period
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Number of hyperoxia episodes (SpO₂ > 94% for ≥ 5 seconds)
Periodo de tiempo: per 9-hour observation period
|
per 9-hour observation period
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Percentage of time spent with SpO₂ < 85%
Periodo de tiempo: per 9-hour observation period
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per 9-hour observation period
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Percentage of time spent with SpO₂ > 94%
Periodo de tiempo: per 9-hour observation period
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per 9-hour observation period
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Percentage of time spent with HR < 100 bpm
Periodo de tiempo: per 9-hour observation period
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per 9-hour observation period
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Number of apnea episodes requiring nurse intervention
Periodo de tiempo: per 9-hour observation period
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tactile stimulation and/or increase in FiO₂ |
per 9-hour observation period
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Need for escalation of respiratory support during the observation period
Periodo de tiempo: per 9-hour observation period
|
Defined as requirement for transition to non-invasive ventilation mode or endotracheal intubation |
per 9-hour observation period
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Infant comfort assessed using the EDIN score (Échelle Douleur Inconfort Nouveau-Né)
Periodo de tiempo: per 9-hour observation period
|
EDIN will be recorded every 3 hours (0-15), yielding up to 3 measurements per 9-hour observation period. The mean EDIN score over each observation period will be used |
per 9-hour observation period
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Gastrointestinal tolerance
Periodo de tiempo: per 9-hour observation period
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Grade 1: good tolerance - enteral feeding maintained at prescribed volume with no significant gastric residuals ; Grade 2: moderate intolerance - enteral feeding volume reduced due to gastric residuals or clinical concern ;Grade 3: poor tolerance - enteral feeding discontinued with initiation of continuous gastric suctioning. The worst grade recorded during each 9-hour observation period will be used as the summary measure for analysis. |
per 9-hour observation period
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Colaboradores e Investigadores
Patrocinador
Patrocinador
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Estimado)
Inicio del estudio
Finalización primaria (Estimado)
Finalización primaria
Finalización del estudio (Estimado)
Finalización del estudio
Fechas de registro del estudio
Enviado por primera vez
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Publicado por primera vez
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización publicada
Última actualización enviada que cumplió con los criterios de control de calidad
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
- Enfermedades urogenitales
- Enfermedades cardiovasculares
- Procesos Patológicos
- Enfermedades urogenitales femeninas y complicaciones del embarazo
- Enfermedades cardíacas
- Trabajo de parto prematuro, obstétrico
- Complicaciones obstétricas del parto
- Complicaciones del embarazo
- Enfermedades de las vías respiratorias
- Arritmias Cardiacas
- Trastornos de la respiración
- Signos y Síntomas Respiratorios
- Condiciones Patológicas, Signos y Síntomas
- Signos y síntomas
- Nacimiento prematuro
- Apnea
- Bradicardia
Otros números de identificación del estudio
Otros números de identificación del estudio
- 2026-00663
- HumRes (Otro identificador: Human research in Switzerland)
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
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