Samson Nathalie, Nadeau Charlène, Vincent Laurence, Cantin Danny, Praud Jean-Paul
Neonatal Respiratory Research Unit, Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada.
Neonatal Respiratory Research Unit, Department of Pharmacology - Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada.
Front Pediatr. 2018 Jan 17;5:296. doi: 10.3389/fped.2017.00296. eCollection 2017.
The use of prolonged respiratory support under the form of high-flow nasal cannula (HFNC) or nasal continuous positive airway pressure (nCPAP) is frequent in newborn infants. Introduction of oral feeding under such nasal respiratory support is, however, highly controversial among neonatologists, due to the fear that it could disrupt sucking, swallowing, and breathing coordination and in turn induce cardiorespiratory events. The recent observation of tracheal aspirations during bottle-feeding in preterm infants under nCPAP justifies the use of animal models to perform more comprehensive physiological studies on the subject, in order to gain further insights for clinical studies. The objective of this study was to assess and compare the impact of HFNC and nCPAP on bottle-feeding in newborn lambs, in terms of bottle-feeding efficiency and safety as well as sucking-swallowing-breathing coordination. Eight full-term lambs were instrumented to record sucking, swallowing, and respiration as well as electrocardiogram and oxygenation. Lambs were bottle-fed in a standardized manner during three randomly ordered conditions, namely nCPAP 6 cmHO, HFNC 7 L/min, and no respiratory support. Results revealed that nCPAP decreased feeding duration [25 vs. 31 s (control) vs. 57 s (HFNC), = 0.03] and increased the rate of milk transfer [2.4 vs. 1.9 mL/s (control) vs.1.1 mL/s (HFNC), = 0.03]. No other indices of bottle-feeding safety or sucking-swallowing-breathing coordination were significantly altered by HFNC or nCPAP. In conclusion, our results obtained in full-term newborn lambs suggest that: (i) nCPAP 6 cmHO, but not HFNC 7 L/min, increases bottle-feeding efficiency; (ii) bottle-feeding is safe under nCPAP 6 cmHO and HFNC 7 L/min, with no significant alteration in sucking-swallowing-breathing coordination. The present informative and reassuring data in full-term healthy lambs must be complemented by similar studies in preterm lambs, including mild-to-moderate respiratory distress alleviated by respiratory support in order to mimic preterm infants with bronchopulmonary dysplasia and pave the way for clinical studies.
在新生儿中，高流量鼻导管（HFNC）或鼻持续气道正压通气（nCPAP）形式的长期呼吸支持使用频繁。然而，在这种鼻呼吸支持下引入经口喂养在新生儿科医生中存在很大争议，因为担心这可能会扰乱吸吮、吞咽和呼吸协调，进而引发心肺事件。最近观察到在nCPAP支持下的早产儿奶瓶喂养期间出现气管误吸，这证明有必要使用动物模型对该主题进行更全面的生理学研究，以便为临床研究获得更多见解。本研究的目的是评估和比较HFNC和nCPAP对新生羔羊奶瓶喂养的影响，包括奶瓶喂养效率和安全性以及吸吮 - 吞咽 - 呼吸协调。八只足月羔羊被安装仪器以记录吸吮、吞咽、呼吸以及心电图和氧合情况。羔羊在三种随机排序的条件下以标准化方式进行奶瓶喂养，即nCPAP 6cmH₂O、HFNC 7L/min和无呼吸支持。结果显示，nCPAP缩短了喂养持续时间[25秒对31秒（对照）对57秒（HFNC），P = 0.03]，并提高了乳汁输送速率[2.4毫升/秒对1.9毫升/秒（对照）对1.1毫升/秒（HFNC），P = 0.03]。HFNC或nCPAP对奶瓶喂养安全性或吸吮 - 吞咽 - 呼吸协调的其他指标没有显著改变。总之，我们在足月新生羔羊中获得的结果表明：（i）6cmH₂O的nCPAP可提高奶瓶喂养效率，而7L/min的HFNC则不能；（ii）在6cmH₂O的nCPAP和7L/min的HFNC下奶瓶喂养是安全的，吸吮 - 吞咽 - 呼吸协调无显著改变。本研究在足月健康羔羊中获得的这些信息丰富且令人安心的数据，必须通过对早产羔羊进行类似研究来补充，包括通过呼吸支持缓解轻度至中度呼吸窘迫，以模拟患有支气管肺发育不良的早产儿，并为临床研究铺平道路。
