Abstract
Aim: Convalescing preterm infants often require non-invasive respiratory support, such as nasal continuous positive airway pressure or high-flow nasal cannulas. One challenging milestone for preterm infants is achieving full oral feeding. Some teams fear nasal respiratory support might disrupt sucking–swallowing–breathing coordination and induce severe cardiorespiratory events. The main objective of this study was to assess the safety of oral feeding of preterm lambs on nasal respiratory support, with or without tachypnoea.Methods: Sucking, swallowing and breathing functions, as well as electrocardiogram, oxygen haemoglobin saturation, arterial blood gases and videofluoroscopic swallowing study were recorded in 15 preterm lambs during bottle-feeding. Four randomly ordered conditions were studied: control, nasal continuous positive airway pressure (6 cmH2O), high-flow nasal cannulas (7 L•min–1), and high-flow nasal cannulas at 7 L•min–1 at a tracheal pressure of 6 cmH2O. The recordings were repeated on days 7–8 and 13–14 to assess the effect of maturation.Results: None of the respiratory support impaired the safety or efficiency of oral feeding, even with tachypnoea. No respiratory support systematically impacted sucking–swallowing–breathing coordination, with or without tachypnoea. No effect of maturation was found.Conclusion: This translational physiology study, uniquely conducted in a relevant animal model of preterm infant with respiratory impairment, shows that nasal respiratory support does not impact the safety or efficiency of bottle-feeding or sucking–swallowing–breathing coordination. These results suggest that clinical studies on bottle-feeding in preterm infants under nasal continuous positive airway pressure and/or high-flow nasal cannulas can be safely undertaken.
Highlights
One criterion commonly used worldwide for discharging preterm infants from the neonatal care unit is their ability to achieve safe and efficient full oral feeding (American Academy of Pediatrics Committee on Fetus and Newborn, 2008)
While Nasal continuous positive airway pressure (nCPAP) distends the upper airways and increases lung volumes by delivering a set level of positive pressure, the high flow rate of gas used with high-flow nasal cannula (HFNC) instead washes the upper airways
Three lambs from the same litter died before postnatal days 13–14 due to pneumonia; their mother died a few days later, strongly suggesting their death was due to a communicable infectious disease
Summary
One criterion commonly used worldwide for discharging preterm infants from the neonatal care unit is their ability to achieve safe and efficient full oral feeding (American Academy of Pediatrics Committee on Fetus and Newborn, 2008). Any delay in achieving this crucial physiological function will delay discharge from the neonatal intensive care unit and might result in growth failure, oral aversion, and poorer neurodevelopmental outcomes (Park et al, 2015; Jadcherla et al, 2017; Walsh et al, 2017; Hatch et al, 2018; Lainwala et al, 2020). Nasal continuous positive airway pressure (nCPAP) and/or high-flow nasal cannulas (HFNCs) are commonly used in convalescing preterm infants to support their persistently impaired respiratory function non-invasively (Lemyre et al, 2016, 2017; Mahajan et al, 2016). These two modes of nasal respiratory support (NRS) act via somewhat different physiological mechanisms. High-flow nasal cannulas may—or may not— provide an unknown level of distending positive pressure, depending on the infant’s weight, the gas flow rate, and the ratio between the diameters of the cannulas and the nares (Nasef et al, 2015)
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