FIRST, DO NO HARM: A Response to “Oral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula”

Dodrill, Pamela; Gosa, Memorie M.; Thoyre, Suzanne M.; Shaker, Catherine; Pados, Britt Frisk; Park, Jinhee; DePalma, Nicole; Hirst, Keith; Larson, Kara; Perez, Jennifer; Hernandez, Kayla

doi:10.1007/s00455-016-9722-x

Cited by 18 publications

(12 citation statements)

References 2 publications

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“…Accordingly, another study did not find any difference between nCPAP and HFNC on the time needed to attain full oral feeding ( 12 ). As recently highlighted, there are no formal data documenting whether the presence of HFNC impairs swallowing function during suckle feeding or promotes tracheal aspiration, which led the authors to determinedly advise against the thoughtless use of oral feeding under HFNC before further information is available ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of Nasal Continuous Positive Airway Pressure and High-Flow Nasal Cannula on Sucking, Swallowing, and Breathing during Bottle-Feeding in Lambs

et al. 2018

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The use of prolonged respiratory support under the form of high-flow nasal cannula (HFNC) or nasal continuous positive airway pressure (nCPAP) is frequent in newborn infants. Introduction of oral feeding under such nasal respiratory support is, however, highly controversial among neonatologists, due to the fear that it could disrupt sucking, swallowing, and breathing coordination and in turn induce cardiorespiratory events. The recent observation of tracheal aspirations during bottle-feeding in preterm infants under nCPAP justifies the use of animal models to perform more comprehensive physiological studies on the subject, in order to gain further insights for clinical studies. The objective of this study was to assess and compare the impact of HFNC and nCPAP on bottle-feeding in newborn lambs, in terms of bottle-feeding efficiency and safety as well as sucking–swallowing–breathing coordination. Eight full-term lambs were instrumented to record sucking, swallowing, and respiration as well as electrocardiogram and oxygenation. Lambs were bottle-fed in a standardized manner during three randomly ordered conditions, namely nCPAP 6 cmH2O, HFNC 7 L/min, and no respiratory support. Results revealed that nCPAP decreased feeding duration [25 vs. 31 s (control) vs. 57 s (HFNC), p = 0.03] and increased the rate of milk transfer [2.4 vs. 1.9 mL/s (control) vs.1.1 mL/s (HFNC), p = 0.03]. No other indices of bottle-feeding safety or sucking–swallowing–breathing coordination were significantly altered by HFNC or nCPAP. In conclusion, our results obtained in full-term newborn lambs suggest that: (i) nCPAP 6 cmH2O, but not HFNC 7 L/min, increases bottle-feeding efficiency; (ii) bottle-feeding is safe under nCPAP 6 cmH2O and HFNC 7 L/min, with no significant alteration in sucking–swallowing–breathing coordination. The present informative and reassuring data in full-term healthy lambs must be complemented by similar studies in preterm lambs, including mild-to-moderate respiratory distress alleviated by respiratory support in order to mimic preterm infants with bronchopulmonary dysplasia and pave the way for clinical studies.

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Section: Discussionmentioning

confidence: 99%

Effects of Nasal Continuous Positive Airway Pressure and High-Flow Nasal Cannula on Sucking, Swallowing, and Breathing during Bottle-Feeding in Lambs

et al. 2018

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“…Feeding infants on continuous positive airway pressure remains controversial. [31][32][33] The benefits of introducing feeding in a critical window must be weighed against the risk of laryngeal penetration, aspiration, and worsening of lung disease. A recent animal study not only provided evidence on safe bottle feeding and maintained sucking-swallowing-breathing coordination, but also on improved efficiency of bottle feeding in preterm and full-term lambs on nasal CPAP.…”

Section: Discussionmentioning

confidence: 99%

Characterization of esophageal motility and esophagogastric junction in preterm infants with bronchopulmonary dysplasia

Rayyan

Omari

Debeer

et al. 2020

Neurogastroenterology Motil

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Background: To characterize esophageal motility and function of the esophagogastric junction (EGJ) in preterm infants with bronchopulmonary dysplasia (BPD). Methods: High-resolution manometry with impedance was used to investigate esophageal motility and EGJ function in 28 tube-fed preterm infants with BPD. Patients with BPD were studied at term age during oral feeding. Thirteen healthy term-aged infants were included as controls. Esophageal analysis derived objective measures to evaluate esophageal contractile vigor, bolus distension pressure, EGJ relaxation, and EGJ barrier function (in rest and during respiration). In addition, we investigated the effect of BPD severity on these measures. Key results: A total of 140 nutritive swallows were analyzed (BPD, n = 92; controls, n = 48). Normal esophageal peristaltic wave patterns were observed in all infants. BPD patients had higher distal contractile esophageal strength compared with controls (Kruskal-Wallis (KW) P = .048), and their deglutitive EGJ relaxation was comparable to controls. Severe BPD patients showed higher bolus distension pressures, higher EGJ resting pressures, and increased EGJ contractile integrals compared with mild BPD patients (Mann-Whitney U P = .009, KW P = .012 and KW P = .028, respectively). Conclusions and Inferences: Preterm infants with BPD consistently present with normal peristaltic esophageal patterns following nutritive liquid swallows. The EGJ barrier tone and relaxation pressure appeared normal. In general, infants with BPD do not have altered esophageal motor function. There is however evidence for increased flow resistance at the EGJ in severe BPD patients possibly related to an increased contractility of the diaphragm.

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“…Introduction of oral feeding under nasal respiratory support is a muchdebated topic among neonatologists, prompted by fear that nCPAP could disrupt sucking, swallowing and breathing coordination and in turn promote cardiorespiratory events. While some teams have claimed success with initiation of oral feeding in immature infants with nCPAP (111-113), many others advocate waiting for weaning of nCPAP or high-flow nasal cannula before any attempt at oral feeding (114,115). Studies in full-term newborn lambs have shown that nCPAP up to 10 cmH 2 O had no deleterious effects on both bottle-feeding efficiency and safety and did not alter nutritive swallowing-breathing coordination in full-term lambs (116).…”

Section: Cardiorespiratory Events Related To Oral Feeding In Preterm mentioning

confidence: 99%

The contribution of ovine models to perinatal respiratory physiology

2018

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The dramatic transition to air breathing at birth represents a true challenge for the newborn infant mammal, a period in which neonatal respiratory diseases are common. Since the 1930s, fetal and newborn lambs have been the model of choice for whole-animal studies on neonatal respiration. The present review aims to illustrate the relevance of ovine models in studying the establishment of successful breathing at birth and its maintenance in the early postnatal period, as well as a number of abnormal conditions that can interfere with these processes.

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FIRST, DO NO HARM: A Response to “Oral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula”

Cited by 18 publications

References 2 publications

Effects of Nasal Continuous Positive Airway Pressure and High-Flow Nasal Cannula on Sucking, Swallowing, and Breathing during Bottle-Feeding in Lambs

Effects of Nasal Continuous Positive Airway Pressure and High-Flow Nasal Cannula on Sucking, Swallowing, and Breathing during Bottle-Feeding in Lambs

Characterization of esophageal motility and esophagogastric junction in preterm infants with bronchopulmonary dysplasia

The contribution of ovine models to perinatal respiratory physiology

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