Effect of pacifier use on oral breathing in healthy newborn infants

Abstract

We tested the hypothesis that the use of a pacifier may affect the ability of some term infants to maintain effective oral breathing during prolonged nasal occlusion. Three nasal occlusion tests without a pacifier and 3 with a pacifier were alternately carried out in 20 healthy term infants (age 2-5 days). Once the infant commenced oral breathing, nasal occlusion was continued for up to 90 sec (prolonged nasal occlusion), provided the infant did not start crying and that arterial oxygen saturation (SaO(2)) did not drop to < or = 80%. The response to nasal occlusion was considered maladaptive if oral breathing was accomplished with signs of upper airway obstruction. After nasal occlusion, the infants succeeded in starting oral breathing in all instances after a delay which was strongly correlated to the drop in SaO(2) (P < 0.001). Once the infants commenced oral breathing, 17/20 infants presented a maladaptive response to 62% of all tests without pacifier, whereas 10/20 infants presented a maladaptive response to 30% of all tests with a pacifier in place (P < 0.001). Following prolonged nasal occlusion, 18 of 19 infants presented a maladaptive response to 84% of all tests without pacifier, whereas 12 of 19 infants presented a maladaptive response to 41% of all tests with a pacifier in place (P < 0.001). Thus, after prolonged nasal occlusion with or without pacifier, the drop in mean SaO(2) from baseline values changed in accordance with an appropriate and maladaptive response (-4 +/- 1 vs. -7 +/- 1; P < 0.001). We conclude that normal term infants often present with a maladaptive response to prolonged nasal occlusion. The use of a pacifier enhances the infant's ability to maintain a more adequate oral air flow.

Effect of pacifier use on mandibular position in preterm infants

“…There is evidence that non‐nutritive sucking advances the jaw and stimulates genioglossus activity, which pulls the back of the tongue forward and so serves to maintain the patency of the nasopharyngeal airway (10). Potentially this could also serve to open the oral airway (9,18); however, in the present study the infants’ lips were consistently closed. In effect the present study used jaw position as a surrogate for changes in tongue position and upper airway dimensions that can be measured by respiration‐timed radiographs (13,15).…”

“…Cozzi and colleagues expanded this hypothesis in 1979, suggesting for the first time that pacifiers might protect infants from SIDS, by keeping the oral airway open, thus preventing a pharyngeal vacuum and the consequent sealing of the airway (6). Subsequently, they proposed that pacifiers may provide an oral airway if the nasal airway is obstructed (9), or may stimulate reflex enhancement of genioglossus activity that would help to maintain the patency of the nasopharyngeal airway (10).…”

“…Further, in older infants a smaller jaw is associated with increased risk of apparent life‐threatening events (14,15); data from timed lateral neck radiographs suggest that this association is mediated by narrowing of the upper airway (15). Finally, pacifier use can improve oral airflow and arterial oxygenation during prolonged nasal occlusion (9).…”

Bilateral Choanal Atresia: Is it Really a Surgical Emergency?

“…Inserting oropharyngeal airway and orogastric tube is a better alternative to intubation/tracheostomy, as it decreases the morbidity associated with emergency procedures. Francesco et al [6] concluded that in case of prolonged nasal obstruction in infant, the use of a pacifier enhances the infant's ability to maintain a more adequate oral air flow.…”

Aeration properties of a new sleeping surface for infants

“…Within the “sleep practices and infant sleep environment” category, well documented risk factors for SIDS include: prone and side‐sleeping positions, soft bedding and surfaces, thermal stress due to overheating or infections with fever, bed sharing between infants and adults, and exposure to tobacco smoke 1, 2, 14, 15. Factors that are shown to reduce the risk of SIDS in the same category include the use of a pacifier at bed time,16 and breastfeeding 17, 18. The leading hypothesis that explains significant risk factors for SIDS in the sleeping environment is the rebreathing hypothesis.…”