Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates

Ferrara, Louisa; Bidiwala, Aneela; Sher, Irene; Pirzada, Melodi; Barlev, Dan M.; Islam, Shahidul; Rosenfeld, Warren; Crowley, C C; Hanna, Nazeeh

doi:10.1038/jp.2016.229

Cited by 53 publications

(22 citation statements)

References 33 publications

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“…A recent study showed that preterm infants under nCPAP have the same ability to initiate pharyngeal reflexive swallowing as their room-air-breathing counterparts and concluded that preterms can protect and clear a pharyngeal bolus with appropriate proximal peristaltic mechanism (12). Conversely, results from a recent videoscopic study in preterm infants suggest that nCPAP alters pharyngeal swallows and increases the risk of tracheal aspiration during oral feeding (20). Overall, our present results showing better oxygenation in nCPAP lambs during bottle-feeding, together with the absence of deleterious cardiac events, is reassuring.…”

Section: Safety Of Bottle-feeding Under Ncpapmentioning

confidence: 99%

Nasal continuous positive airway pressure influences bottle-feeding in preterm lambs

et al. 2017

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BackgroundIn preterm infants, the time from initiation to full oral feeding can take weeks, which represents a very worrisome problem in neonatal medicine. Although current knowledge suggests that oral feeding should be introduced early, this is often delayed due to the need for prolonged nasal continuous positive airway pressure (nCPAP). Indeed, most caregivers fear that nCPAP could disrupt sucking-swallowing-breathing coordination and induce tracheal aspiration. The goal of the present study was to assess the impact of nCPAP delivered by the Infant Flow System on the physiology of sucking-swallowing-breathing coordination during bottle-feeding in preterm lambs over 24 h.MethodsSeventeen lambs (8 control, 9 nCPAP of 6 cmHO) born 14 days prematurely were instrumented to record sucking, swallowing, respiration, ECG, and oxygenation. They were fed via a nasogastric tube for the first 5 days of life until introduction of bottle-feeding every 4 h for 24 h.ResultsnCPAP increased the feeding efficiency while maintaining higher oxygenation without any deleterious cardiorespiratory events. However, coughs were observed in lambs under nCPAP immediately following bottle-feeding and may be related to the high milk flow in preterm lambs.ConclusionFurther studies documenting tracheal aspirations are needed, especially in preterm lambs under nCPAP for moderate respiratory difficulties, to further inform future clinical studies.

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Section: Safety Of Bottle-feeding Under Ncpapmentioning

confidence: 99%

Nasal continuous positive airway pressure influences bottle-feeding in preterm lambs

et al. 2017

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“…Until now, the variable results and conflicting conclusions of the available clinical studies ( 7 – 12 ) have precluded the publication of evidence-based guidelines for feeding infants under NRS. Consequently, initiation of oral feeding in preterm infants under NRS remains a controversial topic among neonatologists ( 9 , 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

“…Given the risk of tracheal aspiration in fragile preterm infants fed orally under nCPAP ( 11 ), we initiated a research program in newborn ovine models a few years ago with the aim of gaining new physiological knowledge on the effect of NRS on the precise coordination between sucking, swallowing, and breathing as well as on bottle-feeding efficiency and safety. We believe that observations in ovine models will ultimately help in designing safer clinical studies.…”

Section: Introductionmentioning

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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“…The impact of pharyngeal pressure generated by this airflow on airway protection is also of concern, as studies have indicated varying level of pressure generated based on patient size and cannula diameter/ nasal occlusion. [73][74][75][76] Some studies suggest the possibility of oral feeding with HFNC, [77][78][79][80][81] and with CPAP, 82,83 while others raise concerns for increased aspiration with nasal CPAP, 84,85 and BiPAP. 86 Without definitive guidance from large studies, the ICU clinician must consider each patient's individual presentation and risk factors, not solely the oxygen delivery mode/level in isolation of these other factors.…”

Section: Timingmentioning

confidence: 99%

Clinical Decision Making in the ICU: Dysphagia Screening, Assessment, and Treatment

2019

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Clinicians often perceive the intensive care unit as among the most intimidating environments in patient care. With the proper training, acquisition of skill, and approach to clinical care, feelings of intimidation may be overcome with the great rewards this level of care has to offer. This review—spanning the ages of birth to senescence and covering oral/nasal endotracheal intubation and tracheostomy—presents a clinically relevant, directly applicable review of screening, assessment, and treatment of dysphagia in the patients who are critically ill for clinical speech–language pathologists and identifies gaps in the clinical peer-reviewed literature for researchers.

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Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates

Abstract: Oral feeding while on-nCPAP significantly increases the risk of laryngeal penetration and tracheal aspiration events. We recommend caution when initiating oral feedings on nCPAP.

Cited by 53 publications

References 33 publications

Nasal continuous positive airway pressure influences bottle-feeding in preterm lambs

Nasal continuous positive airway pressure influences bottle-feeding in preterm lambs

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

Clinical Decision Making in the ICU: Dysphagia Screening, Assessment, and Treatment

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