Nasal Continuous Positive Airway Pressure Inhibits Gastroesophageal Reflux in Newborn Lambs

Abstract

BackgroundUsing esophageal pHmetry, nasal CPAP (nCPAP) has been shown to decrease acid gastroesophageal reflux (GER) in adult humans. Although both GER (mainly non-acid) and nCPAP use are very frequent in newborns, the effect of nCPAP on GER in early life is unknown. Having recently shown that the newborn lamb is a unique model for studying neonatal GER, our main objective was to assess the effect of nCPAP on GER in newborn lambs.MethodsEight newborn lambs, aged 2–3 days, were studied. Continuous esophageal pH-Impedance monitoring and polysomnography were performed for six hours during both spontaneous breathing and nCPAP application at 6 cmH2O (nCPAP6), in a randomized order. Results were compared in the two experimental conditions, as well as without CPAP during the following 6 hours.Resultsi) nCPAP6 virtually abolished GER [mean ±SD reflux number for 6 h = 9.1±8.6 without nCPAP6 vs. 0.6±1 with nCPAP6, P<0.05]; ii) GER number was also reduced during the 6 h-period following nCPAP6 application (18±16 without nCPAP6 vs. 7±8.1 with nCPAP6, P<0.05); iii) nCPAP6 decreased the depth and duration of lower esophageal sphincter relaxation.ConclusionsnCPAP inhibits GER in the newborn lamb. Further clinical studies using different levels of nasal CPAP are needed to confirm this result in human infants.

Influence of intrapulmonary percussive ventilation in upright position on gastro‐oesophageal reflux in infants

“…37 More recent results (in animals) suggest that CPAP acts by decreasing the duration and depth of LOS relaxations. 38 These findings support our results, although IPV delivers an intermittent positive pressure during breathing.…”

“…Considering that the majority of reflux events occur during periods of transient relaxation, it appeared important to investigate the effect of CPAP under such a condition . More recent results (in animals) suggest that CPAP acts by decreasing the duration and depth of LOS relaxations . These findings support our results, although IPV delivers an intermittent positive pressure during breathing.…”

Effect of nasal noninvasive respiratory support methods on pharyngeal provocation-induced aerodigestive reflexes in infants

“…The use of CPAP has been shown to inhibit gastroesophageal reflux in adults and newborn lambs (5,19). The adult study proposed that the mechanism behind this could be due to passive elevation of basal midesophageal and LES pressures (19).…”

The influence of Intrapulmonary percussive ventilation on gastroesophageal reflux in infants under the age of 1 year

“…The impact of Continuous Positive Airway Pressure (CPAP) on the incidence of GER in infants is debated since CPAP was reported to be as well a risk as a protective factor for GER in animal models. 20,21 CPAP is suggested to possibly decrease the duration and depth of lower esophageal sphincter (LES) relaxations and reduces the susceptibility to reflux. 21 It is known that transient LES relaxations are the predominant mechanisms of GER.…”

“…20,21 CPAP is suggested to possibly decrease the duration and depth of lower esophageal sphincter (LES) relaxations and reduces the susceptibility to reflux. 21 It is known that transient LES relaxations are the predominant mechanisms of GER. [22][23][24] Nasal intermittent positive pressure ventilation and nasal high-frequency oscillatory ventilation were reported to inhibit GER in full-term newborn lambs.…”