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Absence of Effect of Nasal Continuous Positive Airway Pressure on the Esophageal Phase of Nutritive Swallowing in Newborn Lambs

Djeddi, Djamal*; Cantin, Danny; Samson, Nathalie; Tian, Hao; Praud, Jean-Paul

Journal of Pediatric Gastroenterology and Nutrition: August 2013 - Volume 57 - Issue 2 - p 188–191
doi: 10.1097/MPG.0b013e318292b3b2
Original Article: Hepatology and Nutrition

Objectives: It is presently recommended that oral feeding be started in premature infants as soon as possible, often at an age at which nasal continuous positive airway pressure (nCPAP) is still required for ventilatory support. Our previous data showed that application of nCPAP up to 10 cmH2O in full-term lambs had no deleterious effect on cardiorespiratory safety, feeding efficiency, or on nutritive swallowing–breathing coordination. Besides fear of swallowing–breathing coordination disturbances, esophageal motility disruption by nCPAP could be a reason to delay oral feeding. To our knowledge, no study has focused on the effects of nCPAP on esophageal motility in the neonatal period. The aim of the present study was therefore to further assess the effects of nCPAP on oral feeding by assessing its effects on the esophageal phase of nutritive swallowing (nutritive esophagodeglutition).

Methods: Six full-term lambs, ages 2 to 3 days, underwent esophageal multichannel intraluminal impedance-pH monitoring. Lambs were bottle-fed under 2 randomized conditions, namely spontaneous breathing and nCPAP 6 cmH2O.

Results: Beyond confirmation of unaltered feeding efficiency, analysis of multiple variables measured by impedance monitoring revealed that nCPAP 6 does not alter nutritive esophagodeglutition in any way (nCPAP vs spontaneous breathing, P > 0.1 for all variables).

Conclusions: offering further support to neonatologists pleading for initiation of oral feeding in infants still on nCPAP, the present results set the foundations for similar clinical studies in preterm human infants to confirm the absence of effects of nCPAP on nutritive swallowing.

*Department of Pediatrics, Université Picardie Jules Verne, Amiens, France.

Departments of Pediatrics and Physiology, Neonatal Respiratory Research Unit, Université de Sherbrooke, Quebec, Canada.

Address correspondence and reprint requests to Djamal Djeddi, MD, PhD, Department of Pediatrics, Université Picardie Jules Verne, Place V Pauchet, 80054 Amiens, France (e-mail:

Received 3 December, 2012

Accepted 15 March, 2013

D.D. was supported by the Department of Pediatrics, Amiens University Hospital, France and the 2011 Chiesi-JFRN scholarship. The study was also supported by the Canada Research Chair in Neonatal Respiratory Physiology allocated to J.-P.P. and the Canadian Institutes of Health Research. J.-P.P. is a member of the FRSQ-funded Clinical Research Center Étienne-Le Bel, Sherbrooke University Hospital, Quebec, Canada.

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,