Department of Pediatrics, Université Picardie Jules Verne, Amiens, France.
J Pediatr Gastroenterol Nutr. 2013 Aug;57(2):188-91. doi: 10.1097/MPG.0b013e318292b3b2.
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).
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 cmH(2)O.
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).
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.
目前建议早产儿尽快开始口服喂养，通常在需要鼻持续气道正压通气（nCPAP）进行通气支持的年龄。我们之前的数据表明，在足月羔羊中应用高达 10cmH2O 的 nCPAP 对心肺安全性、喂养效率或营养性吞咽-呼吸协调性没有不良影响。除了担心吞咽-呼吸协调性紊乱外，nCPAP 对食管运动的干扰也可能是延迟口服喂养的一个原因。据我们所知，尚无研究关注 nCPAP 对新生儿期食管运动的影响。因此，本研究的目的是通过评估 nCPAP 对营养性吞咽的食管相（营养性食管吞咽）的影响，进一步评估 nCPAP 对口服喂养的影响。
6 只 2 至 3 天大的足月羔羊接受食管多通道腔内阻抗-pH 监测。羔羊在 2 种随机条件下进行奶瓶喂养，即自主呼吸和 nCPAP 6cmH(2)O。
除了确认喂养效率没有改变外，阻抗监测测量的多个变量的分析表明，nCPAP 6 不会以任何方式改变营养性食管吞咽（nCPAP 与自主呼吸相比，所有变量的 P>0.1）。
本研究结果为在早产儿中进行类似的临床研究提供了基础，证实 nCPAP 对营养性吞咽没有影响，进一步支持了提倡在仍接受 nCPAP 治疗的婴儿中开始口服喂养的新生儿科医生。
