Several factors could explain the beneficial effects observed with NAVA in these three children who had severe respiratory distress. First, asynchrony is associated with increased morbidity, a longer duration of ventilation, and a longer hospital stay [9] [10] [11] . There are few pediatric data published regarding the adverse effects of long-term asynchrony between mandatory ventilation and the respiratory efforts of children, but it has been shown that infant-ventilator asynchrony (both inspiratory and expiratory asynchrony) may affect more than 50% of the total breath duration [12] . Second, NAVA provides assistance in synchronization, as well as in pressure assistance in Recording began with the establishment of NAVA. Upper panels: After starting NAVA, (A) FiO 2 gradually decreased to 35%, and (B) tidal volume became variable from one cycle to another ranging from 5 to 30 ml. Middle panels: Variability was also observed in measurements of pressure: (C) mean airway pressure, (D) peak inspiratory pressure. Bottom panels: (E) After starting NAVA, the respiratory rate became very variable over time. (F) Edi max corresponds to the peak of electrical activity of the diaphragm. The highest Edi values (recorded between 19:00 and 22:00) drove assistance with the highest pressures. A decrease in signal intensity was accompanied by a decrease in pressure, corresponding to an improvement in lung function. The requirement for oxygen decreased at the same time. Abbreviations: FiO 2 , fraction of inspired oxygen; Edi, electrical activity of the diaphragm; NAVA, neurally adjusted ventilatory assist.