Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates

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.

MeSH terms

  • Continuous Positive Airway Pressure / adverse effects
  • Continuous Positive Airway Pressure / methods
  • Deglutition / physiology*
  • Deglutition Disorders / diagnostic imaging
  • Deglutition Disorders / physiopathology*
  • Female
  • Fluoroscopy
  • Humans
  • Infant, Newborn
  • Infant, Premature / growth & development
  • Infant, Premature, Diseases / diagnostic imaging
  • Infant, Premature, Diseases / physiopathology*
  • Male
  • Pharynx / physiopathology*
  • United States