• C G de Waal, G J Hutten, J V Kraaijenga, F H de Jongh, and A H van Kaam.
• Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
• Arch. Dis. Child. Fetal Neonatal Ed. 2017 Sep 1; 102 (5): F434-F438.

ObjectiveTo 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).DesignProspective observational study.SettingNeonatal intensive care unit.PatientsStable preterm infants transitioned from nCPAP to HFNC using a 1:1 pressure to flow ratio.InterventionsThe electrical activity of the diaphragm was measured by transcutaneous electromyography (dEMG) from 30 min before until 3 hours after the transition.Main Outcome MeasuresAt eight time points after the transition to HFNC, diaphragmatic activity was compared with the baseline on nCPAP. Percentage change in amplitudedEMG, peakdEMG and tonicdEMG were calculated. Furthermore, changes in respiratory rate, heart rate and fraction of inspired oxygen (FiO2) were analysed.ResultsThirty-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 amplitudedEMG at t=180 min: 2.81% (-21.51-14.10)). The respiratory rate, heart rate and FiO2 remained stable during the 3-hour measurement.ConclusionsNeural 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.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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