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Effects of Nasal Respiratory Support on Laryngeal and Esophageal Reflexes in Preterm Lambs

Pediatric Research (2023)Cite this article

Abstract

Background

Significant cardiorespiratory events can be triggered in preterm infants as part of laryngeal chemoreflexes (LCRs) and esophageal reflexes (ERs). We previously showed that nasal continuous positive airway pressure (nCPAP) blunted the cardiorespiratory inhibition induced with LCRs. Therefore, we aimed to compare the effects of nCPAP and high-flow nasal cannulas (HFNC) on the cardiorespiratory events induced during LCRs and ERs. The hypothesis is that nCPAP but not HFNC decreases the cardiorespiratory inhibition observed during LCRs and ERs.

Methods

Eleven preterm lambs were instrumented to record respiration, ECG, oxygenation, and states of alertness. LCRs and ERs were induced during non-rapid eye movement sleep in a random order under these conditions: nCPAP 6 cmH2O, HFNC 7 L/min, high-flow nasal cannulas 7 L/min at a tracheal pressure of 6 cmH2O, and no respiratory support.

Results

nCPAP 6 cmH2O decreased the cardiorespiratory inhibition induced with LCRs, but not with ERs in preterm lambs. This blunting effect was less marked with HFNC 7 L/min, even when the tracheal pressure was maintained at 6 cmH2O.

Conclusions

nCPAP might be a treatment for cardiorespiratory events related to LCRs in newborns, either in the context of laryngopharyngeal refluxes or swallowing immaturity. Our preclinical results merit to be confirmed through clinical studies.

Impact

  • Laryngeal chemoreflexes can be responsible for significant cardiorespiratory inhibition in newborns, especially preterm.

  • Nasal continuous positive airway pressure at 6 cmH2O significantly decreased this cardiorespiratory inhibition.

  • High-flow nasal cannulas at 7 L/min had a lesser effect than nasal continuous positive airway pressure.

  • Esophageal stimulation was responsible for a smaller cardiorespiratory inhibition, which was not significantly modified by nasal continuous positive airway pressure or high-flow nasal cannulas.

  • Nasal continuous positive airway pressure should be tested for its beneficial effect on cardiorespiratory events related to laryngeal chemoreflexes in preterm newborns.

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Fig. 1: Effect of nasal respiratory support on laryngeal chemoreflexes in one preterm lamb on postnatal day 7 during NREM sleep.
Fig. 2: Effect of nasal respiratory support on the cardiac inhibitory components of laryngeal chemoreflexes.
Fig. 3: Effect of nasal respiratory support on the respiratory inhibitory components of laryngeal chemoreflexes.
Fig. 4: Effect of nasal respiratory support on the respiratory inhibitory components of esophageal reflexes.
Fig. 5: Effect of nasal respiratory support on the cardiac inhibitory components of esophageal chemoreflexes.

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Data availability

All data generated or analyzed during this study is included in this published article [and its supplementary information files].

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Funding

This study was supported by the Canada Research Chair in Neonatal Respiratory Physiology and an operating grant (CIHR #15558) from the Canadian Institutes of Health Research allocated to J.P.P. E.F.P. and J.P.P. are members of the Sherbrooke University Hospital Research Center, the Quebec Respiratory Health Research Network, and the Quebec Research Network on Perinatal Determinants of Children Health.

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Authors and Affiliations

  1. Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, University of Sherbrooke, Sherbrooke, QC, J1H 5N4, Canada

    Basma F. Elsedawi, Nathalie Samson, Charlène Nadeau, Arianne Charette, Angélique Lehoux, Étienne Fortin-Pellerin & Jean-Paul Praud

  2. Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Arab Republic of Egypt

    Basma F. Elsedawi

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  1. Basma F. Elsedawi
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Contributions

N.S., C.N., E.F.P., and J.P.P. conceived the research and designed the protocol. N.S. and C.N. performed the deliveries. B.F.E., N.S., C.N., A.C., and A.L. ensured the care of the preterm lambs. B.F.E., N.S., and C.N. performed animal experiments. B.F.E., N.S., C.N., and A.C. analyzed the data. B.F.E., N.S., E.F.P., and J.P.P. interpreted the results. B.F.E. prepared the figures and wrote the first draft of the manuscript. N.S. and J.P.P. revised the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Jean-Paul Praud.

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Elsedawi, B.F., Samson, N., Nadeau, C. et al. Effects of Nasal Respiratory Support on Laryngeal and Esophageal Reflexes in Preterm Lambs. Pediatr Res (2023). https://doi.org/10.1038/s41390-023-02883-w

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  • DOI: https://doi.org/10.1038/s41390-023-02883-w

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