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Effect of pacifier use on oral breathing in healthy newborn infants
Francesco Cozzi1, Francesco Morini, Claudio Tozzi
1Pediatric Surgery Unit, Policlinico Umberto I, University of Rome "La Sapienza," Rome, Italy.
Insights
Pacifiers help healthy newborns breathe orally during nasal blockage. This study shows pacifiers improve airway function in infants facing breathing challenges, reducing maladaptive responses.
Area of Science:
- Neonatal physiology
- Infant respiratory control
Background:
- Newborns utilize both nasal and oral breathing.
- The transition to oral breathing during nasal occlusion is critical for maintaining oxygenation.
Purpose of the Study:
- To investigate the effect of pacifier use on oral breathing effectiveness in term infants during prolonged nasal occlusion.
- To assess the incidence of maladaptive respiratory responses with and without pacifier use.
Main Methods:
- Healthy term infants (2-5 days old) underwent repeated nasal occlusion tests, with and without pacifiers.
- Tests involved prolonged nasal occlusion (up to 90 seconds) while monitoring for oral breathing, crying, and arterial oxygen saturation (SaO2).
- Maladaptive responses were identified by signs of upper airway obstruction during oral breathing.
Main Results:
- Infants initiated oral breathing after a delay, correlated with SaO2 drop.
- A significant majority of infants showed maladaptive responses without pacifiers (62% during initial oral breathing, 84% during prolonged occlusion).
- Pacifier use reduced maladaptive responses (30% during initial oral breathing, 41% during prolonged occlusion) and improved oral airflow.
Conclusions:
- Normal term infants frequently exhibit maladaptive breathing responses to prolonged nasal occlusion.
- Pacifier use significantly enhances an infant's ability to maintain effective oral airflow and oxygenation during nasal occlusion.
- Findings suggest pacifiers may play a role in supporting respiratory stability in newborns.
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.