A novel method of synchronization, neurally adjusted ventilatory assist (NAVA) uses electrodes on a functional naso/orogastric tube (Edi catheter) to detect diaphragm contractions and time the onset, duration, and peak inspiratory pressure of supporting breaths with the electrical activity of the diaphragm (Edi) [Sinderby]. NAVA can be used with both invasive and non-invasive ventilation modalities, and there have been several small studies examining invasive NAVA in children and adults [Stein, de la Olivia]. Fewer studies have examined NIV NAVA in these populations, and only two clinical trials have examined NIV NAVA in premature neonates [Beck, Lee]. Beck and colleagues in Canada showed feasibility and preservation of synchrony during NIV NAVA in premature neonates [Beck]. Lee and colleagues in Korea showed fewer asynchrony events, lower trigger delay, and lower peak inspiratory pressures with NIV NAVA compared to non-invasive pressure support ventilation in premature neonates [Lee]. Neither study examined work of breathing (WOB) in preterm neonates ventilated with NIV NAVA.