Assessment of effect of nasal continuous positive pressure on laryngeal opening using fibre optic laryngoscopy

Gaon, P; Lee, S; Hannan, Swarnali Ahmed; Ingram, D.; Milner, Anthony

doi:10.1136/fn.80.3.f230

Cited by 36 publications

(15 citation statements)

References 15 publications

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“…Nasal CPAP has been previously reported to induce dilatation of laryngeal opening in preterm infants (9). On this basis, several neonatology teams are reluctant to initiate oral feeding in infants receiving nCPAP (23), probably fearing the cardiorespiratory consequences of triggering laryngeal chemoreflexes due to increased laryngeal penetration of milk.…”

Section: Safety Of Bottle-feeding During Ncpapmentioning

confidence: 99%

Effects of nasal continuous positive-airway pressure on nutritive swallowing in lambs

Bernier

Catelin

Ahmed

et al. 2012

Journal of Applied Physiology

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Praud JP. Effects of nasal continuous positive-airway pressure on nutritive swallowing in lambs. J Appl Physiol 112: 1984 -1991, 2012. First published April 12, 2012 doi:10.1152/japplphysiol.01559.2011.-Current knowledge suggests that, to be successful, oral feeding in preterm infants should be initiated as soon as possible, often at an age where immature respiration still requires ventilatory support in the form of nasal continuous positive airway pressure (nCPAP). While some neonatologist teams claim great success with initiation of oral feeding in immature infants with nCPAP, others strictly wait for this ventilatory support to be no longer necessary before any attempt at oral feeding, fearing laryngeal penetration and tracheal aspiration. Therefore, the aim of the present study was to provide a first assessment of the effect of various levels of nCPAP on bottle-feeding in a neonatal ovine model, including feeding safety, feeding efficiency, and nutritive swallowing-breathing coordination. Eight lambs born at term were surgically instrumented 48 h after birth to collect recordings of electrical activity of laryngeal constrictor muscle, electrocardiography, and arterial blood gases. Two days after surgery, lambs were bottle-fed under five randomized nCPAP conditions, including without any nCPAP or nasal mask and nCPAP of 0, 4, 7, and 10 cmH2O. Results revealed that application of nCPAP in the full-term lamb had no deleterious effect on feeding safety and efficiency or on nutritive swallowing-breathing coordination. The present study provides a first and unique insight on the effect of nCPAP on oral feeding, demonstrating its safety in newborn lambs born at term. These results open the way for further research in preterm lambs to better mimic the problems encountered in neonatology.

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Section: Safety Of Bottle-feeding During Ncpapmentioning

confidence: 99%

Effects of nasal continuous positive-airway pressure on nutritive swallowing in lambs

Bernier

Catelin

Ahmed

et al. 2012

Journal of Applied Physiology

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“…The physiological effects of NCPAP include improved oxygenation2 3 and lung function,4 5 reduced upper airway resistance,6 7 stenting of the upper airway,8 preservation of lung volume9 and, at least with some devices, reduced work of breathing 10…”

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confidence: 99%

Randomised crossover trial of four nasal respiratory support systems for apnoea of prematurity in very low birthweight infants

Pantalitschka

Sievers

Urschitz

et al. 2009

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…However, laryngeal functions, such as nonnutritive swallowing (NNS), which fulfils the important task of clearing upper airways from secretions and liquids refluxed from the stomach, have not been specifically assessed in newborns during nasal CPAP, aside from one study wherein nasal CPAP was shown to increase laryngeal opening (5). We recently reported that a nasal CPAP of 6 cmH 2 O inhibits spontaneous NNS in newborn lambs during quiet sleep (QS) (19).…”

mentioning

confidence: 99%

Origins of the inhibiting effects of nasal CPAP on nonnutritive swallowing in newborn lambs

Samson¹,

Roy²,

Ouimet³

et al. 2008

Journal of Applied Physiology

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The present study investigated the mechanism by which continuous positive airway pressure (CPAP) suppresses nonnutritive swallowing (NNS) during quiet sleep (QS) in newborn lambs. Eighteen full-term lambs were chronically instrumented and evenly distributed into three separate groups to determine the extent to which modulation of NNS may be attributed to stimulation of upper airway and/or bronchopulmonary mechanoreceptors. Six lambs were tracheotomized, six other lambs underwent a two-step bilateral intrathoracic vagotomy, and the remaining six lambs underwent chronic laryngotracheal separation (isolated upper airway group). Forty-eight hours after surgery, each nonsedated lamb underwent polysomnographic recordings on three consecutive days. States of alertness, NNS and respiratory movements were recorded. Results demonstrate that a CPAP of 6 cmH2O inhibited NNS during QS while administered directly on the lower airways and that bivagotomy prevented this inhibition. However, application of CPAP on the upper airways only also inhibited NNS during QS. Finally, the application of a CPAP of 6 cmH2O had no systematic effect on NNS-breathing coordination (assessed by the respiratory phase preceding and following NNS). In conclusion, our results suggest that bronchopulmonary receptors are implicated in the inhibiting effects of nasal CPAP of 6 cmH2O on NNS in all our experimental conditions, whereas upper airway receptors are only implicated in certain conditions.nasal and tracheal continuous positive airway pressure; vagotomy; laryngotracheal separation; bronchopulmonary receptors NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) has been used in newborns for a number of years for treating respiratory distress syndrome and apneas of prematurity and as a bridge between endotracheal tube ventilation and spontaneous ventilation (4, 6, 10). However, laryngeal functions, such as nonnutritive swallowing (NNS), which fulfils the important task of clearing upper airways from secretions and liquids refluxed from the stomach, have not been specifically assessed in newborns during nasal CPAP, aside from one study wherein nasal CPAP was shown to increase laryngeal opening (5). We recently reported that a nasal CPAP of 6 cmH 2 O inhibits spontaneous NNS in newborn lambs during quiet sleep (QS) (19). Although such effects were previously reported for waterinduced swallowing in conscious adult humans (12), the precise mechanism by which swallowing is inhibited by nasal CPAP remains unclear. Recent findings suggest it may be mediated by mechanoreceptors in the upper airways or by bronchopulmonary slowly adapting stretch receptors (SARs). Indeed, a recent study showed that application of CPAP on isolated larynx enhances laryngeal constrictor muscle (thyroarytenoid) activity in piglets (22). Alternatively, continuous lung inflation induced by negative extrathoracic pressure in awake adult humans also inhibits water-triggered swallows (7), suggesting that SARs can modulate swallowing. According to the authors, the latter hypothesis was f...

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Assessment of effect of nasal continuous positive pressure on laryngeal opening using fibre optic laryngoscopy

Cited by 36 publications

References 15 publications

Effects of nasal continuous positive-airway pressure on nutritive swallowing in lambs

Effects of nasal continuous positive-airway pressure on nutritive swallowing in lambs

Randomised crossover trial of four nasal respiratory support systems for apnoea of prematurity in very low birthweight infants

Origins of the inhibiting effects of nasal CPAP on nonnutritive swallowing in newborn lambs

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