title: Diaphragmatic activity during weaning from respiratory support in preterm infants.
abstract: OBJECTIVE
  To determine if weaning from nasal continuous positive airway pressure (nCPAP) to lesser supportive low flow nasal cannula (LFNC) results in a change in electrical activity of the diaphragm in preterm infants.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Neonatal intensive care unit.
  
  
  METHODS
  Stable preterm infants weaned from nCPAP to LFNC (1 L/min).
  
  
  METHODS
  Change in diaphragmatic activity, expressed as amplitude, peak and tonic activity, measured by transcutaneous electromyography (dEMG) from 30 min before (baseline) until 180 min after weaning. Subgroup analysis was performed based on success or failure of the weaning attempt.
  
  
  RESULTS
  Fifty-nine preterm infants (gestational age: 29.0±2.4 weeks, birth weight: 1210±443 g) accounting for 74 weaning attempts were included. A significant increase in dEMG amplitude (median, IQR: 21.3%, 3.6-41.4), peak (22.1%, 8.7-40.5) and tonic activity (14.3%, -1.9-38.1) was seen directly after weaning. This effect slowly decreased over time. Infants failing the weaning attempt tended to have a higher diaphragmatic activity than those successfully weaned.
  
  
  CONCLUSIONS
  Weaning from nCPAP to LFNC leads to an increase in diaphragmatic activity measured by dEMG and is most prominent in preterm infants failing the weaning attempt. dEMG monitoring might be a useful parameter to guide weaning from respiratory support in preterm infants.
authors: Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors: Juliette V
authors: JV
authors: Kraaijenga
authors: Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors: Cornelia G
authors: CG
authors: de Waal
authors: Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors: Gerard J
authors: GJ
authors: Hutten
authors: Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors: Frans H
authors: FH
authors: de Jongh
authors: Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors: Anton H
authors: AH
authors: van Kaam
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods*; D003964:Diaphragm / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011446:Prospective Studies; D056152:Respiratory Rate / Q000502:physiology*; D015300:Ventilator Weaning / Q000009:adverse effects / Q000379:methods*
keywords: Neonatology; Respiratory support; diaphragmatic activity; low flow nasal cannula; nCPAP