title: Electrical activity of the diaphragm during nCPAP and high flow nasal cannula.
abstract: OBJECTIVE
  To determine if the electrical activity of the diaphragm, as measure of neural respiratory drive and breathing effort, changes over time in preterm infants transitioned from nasal continuous positive airway pressure (nCPAP) to high flow nasal cannula (HFNC).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Neonatal intensive care unit.
  
  
  METHODS
  Stable preterm infants transitioned from nCPAP to HFNC using a 1:1 pressure to flow ratio.
  
  
  METHODS
  The electrical activity of the diaphragm was measured by transcutaneous electromyography (dEMG) from 30 min before until 3 hours after the transition.
  
  
  METHODS
  At eight time points after the transition to HFNC, diaphragmatic activity was compared with the baseline on nCPAP. Percentage change in amplitudedEMG, peakdEMGand tonicdEMGwere calculated. Furthermore, changes in respiratory rate, heart rate and fraction of inspired oxygen (FiO2) were analysed.
  
  
  RESULTS
  Thirty-two preterm infants (mean gestational age: 28.1±2.2 weeks, mean birth weight: 1118±368 g) were included. Compared with nCPAP, the electrical activity of the diaphragm did not change during the first 3 hours on HFNC (median (IQR) change in amplitudedEMGat t=180 min: 2.81% (-21.51-14.10)). The respiratory rate, heart rate and FiO2remained stable during the 3-hour measurement.
  
  
  CONCLUSIONS
  Neural respiratory drive and breathing effort assessed by electrical activity of the diaphragm is similar in the first 3 hours after transitioning stable preterm infants from nCPAP to HFNC with a 1:1 pressure-to-flow ratio.
authors.affiliation: Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: C G
authors.initials: CG
authors.lastname: de Waal
authors.affiliation: Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Hutten
authors.affiliation: Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: J V
authors.initials: JV
authors.lastname: Kraaijenga
authors.affiliation: Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: F H
authors.initials: FH
authors.lastname: de Jongh
authors.affiliation: Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: A H
authors.initials: AH
authors.lastname: van Kaam
mesh_terms: D045422:Continuous Positive Airway Pressure; D003964:Diaphragm / Q000502:physiology*; D004576:Electromyography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D010100:Oxygen / Q000378:metabolism; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011446:Prospective Studies; D056152:Respiratory Rate / Q000502:physiology
chemical_list: D010100:Oxygen
keywords: Diaphragmatic activity; High flow nasal cannula; Respiratory support; nCPAP