Upper airway patency in the human infant: influence of airway pressure and posture

We have determined the influence of transmural pressure and neck posture on upper airway patency in infants after death. In natural resting postures, the airway was closed at transmural pressures not exceeding those normally seen during peak inspiratory airflow in the living infant, implying that a neuromuscular mechanism is necessary to maintain airway patency during life. Neck flexion raised closing pressure, making the airway more susceptible to collapse, whereas neck extension lowered closing pressure, making the airway more resistant to collapse. When the angle of flexion was kept constant, closing pressure was not significantly altered by turning the head or positioning the infant prone. Pressures above the corresponding closing pressure were required to reopen the closed airway, suggesting that the walls of the closed airway tended to adhere and implying that surface forces can impose an added load to airway-maintaining musculature during obstructive apnea in the living infant.