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Nasal continuous positive airway pressure influences bottle-feeding in preterm lambs
Nathalie Samson1, Audrey Michaud1, Rahmeh Othman1
1Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology - Physiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Insights
Nasal continuous positive airway pressure (nCPAP) in preterm lambs did not disrupt feeding coordination but improved feeding efficiency and oxygenation. Coughing was observed, warranting further investigation into tracheal aspiration risks.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Infant Nutrition
Background:
- Delayed oral feeding in preterm infants is a significant clinical challenge.
- Nasal continuous positive airway (nCPAP) use is often linked to delayed feeding due to concerns about cardiorespiratory coordination and aspiration.
- Early oral feeding is recommended but frequently postponed in neonates requiring nCPAP.
Purpose of the Study:
- To evaluate the effect of nCPAP on sucking-swallowing-breathing coordination during bottle-feeding in preterm lambs.
- To assess the physiological impact of nCPAP on feeding in a preterm lamb model.
Main Methods:
- Seventeen preterm lambs (born 14 days early) were studied over 24 hours.
- Nine lambs received nCPAP (6 cmH2O), while 8 served as controls.
- Physiological parameters including sucking, swallowing, respiration, ECG, and oxygenation were monitored during bottle-feeding.
Main Results:
- nCPAP administration improved feeding efficiency and maintained higher oxygenation levels.
- No adverse cardiorespiratory events were observed in lambs receiving nCPAP.
- Coughing occurred post-feeding in the nCPAP group, potentially due to high milk flow.
Conclusions:
- nCPAP delivered via the Infant Flow System appears safe for feeding coordination in preterm lambs.
- Further research is required to investigate the incidence of tracheal aspiration in preterm infants on nCPAP.
- Findings may inform clinical practices regarding early oral feeding in neonates with respiratory support.
Abstract:
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 cmH2O) 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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