经鼻持续气道正压通气对新生儿咽吞咽的影响。
Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates.
作者信息
Ferrara L, Bidiwala A, Sher I, Pirzada M, Barlev D, Islam S, Rosenfeld W, Crowley C C, Hanna N
机构信息
Division of Pediatric Gastroenterology, Children's Medical Center at Winthrop University Hospital, Mineola, NY, USA.
Division of Respiratory and Sleep Medicine, Children's Hospital at Montefiore, Bronx, NY, USA.
出版信息
J Perinatol. 2017 Apr;37(4):398-403. doi: 10.1038/jp.2016.229. Epub 2017 Jan 5.
OBJECTIVE
Feeding neonates orally while on nasal continuous positive airway pressure (nCPAP) is a common practice. We hypothesize that pressurized airflow provided by nCPAP will alter the swallowing mechanism in neonates, increasing the risk of aspiration during oral feeding.
STUDY DESIGN
Infants receiving nCPAP with a RAM cannula and tolerating at least 50% of their feeding orally were included in the study (one term; six preterm infants). Each participant underwent a videofluoroscopic swallow study while on nCPAP and off nCPAP. A non-parametric signed-rank test was used for paired data.
RESULT
The incidence of deep penetration (P=0.03) and aspiration (P=0.01) decreased significantly off-nCPAP compared with on-nCPAP. However, the incidence of mild penetration (P=0.65) and nasopharyngeal reflux (P=0.87) remained the same under both conditions.
CONCLUSION
Oral feeding while on-nCPAP significantly increases the risk of laryngeal penetration and tracheal aspiration events. We recommend caution when initiating oral feedings on nCPAP.
目的
在新生儿接受鼻持续气道正压通气（nCPAP）时经口喂养是一种常见做法。我们推测，nCPAP提供的加压气流会改变新生儿的吞咽机制，增加经口喂养期间误吸的风险。
研究设计
纳入使用RAM插管接受nCPAP且经口喂养至少50%奶量的婴儿（1名足月儿；6名早产儿）。每位参与者在使用nCPAP和不使用nCPAP时均接受视频荧光吞咽研究。配对数据采用非参数符号秩检验。
结果
与使用nCPAP时相比，不使用nCPAP时深度穿透（P=0.03）和误吸（P=0.01）的发生率显著降低。然而，在两种情况下，轻度穿透（P=0.65）和鼻咽反流（P=0.87）的发生率保持不变。
结论
使用nCPAP时经口喂养会显著增加喉穿透和气管误吸事件的风险。我们建议在开始对使用nCPAP的婴儿进行经口喂养时要谨慎。
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