Effects of nasal continuous positive airway pressure (NCPAP) on breathing pattern in spontaneously breathing premature newborn infants

Abstract.

Objective: The aim of the study was to assess the influence of nasal continuous positive airway pressure (NCPAP) on breathing pattern in preterm newborns. Design: Prospective study. Setting: Neonatal intensive care unit. Patients: Ten premature newborn infants on NCPAP (gestational age range from 27 to 32 weeks, mean birth weight 1300±460 g) admitted in our neonatal intensive care unit (NICU) for respiratory distress syndrome. Methods: Breathing patterns and changes in lung volumes level were obtained using respiratory inductive plethysmography (RIP), at random CPAP levels (0, 2, 4, 6 and 8 cmH₂0). Raw data were analysed for end-expiratory lung volume level (EELV-level), tidal volume (Vt), respiratory rate, phase angle and labour breathing index (LBI). Results: CPAP increased EELV-level by 2.1±0.3×Vt from 0 to 8 cmH₂0 (p<0.01). Vt increased by 43% from CPAP of 0 cmH₂0 to CPAP of 8 cmH₂0 (p<0.01). We also found that CPAP lowered the phase angle (from 76±21° at CPAP of 0 cmH₂0 to 30±15° at CPAP of 8 cmH₂0; p<0.01 ) and LBI (from 1.7±0.8 at CPAP of 0 cmH₂0 to 1.2±0.3 at CPAP of 8 cmH₂0; p<0.05). Conclusion: NCPAP improves the breathing strategy of premature infants with respiratory failure, as reflected by improved thoraco-abdominal synchrony, increased Vt and reduction of the LBI. This effect is associated with an increase in EELV-level with CPAP level. However, further investigations are necessary to establish the best CPAP level that ensures both safety and efficiency.