Nasal Continuous Positive Airway Pressure Inhibits Gastroesophageal Reflux in Newborn Lambs

Background: Using esophageal pHmetry, nasal CPAP (nCPAP) has been shown to decrease acid gastroesophageal reflux (GER) in adult humans. Although both GER (mainly non-acid) and nCPAP use are very frequent in newborns, the effect of nCPAP on GER in early life is unknown. Having recently shown that the newborn lamb is a unique model for studying neonatal GER, our main objective was to assess the effect of nCPAP on GER in newborn lambs. Methods: Eight newborn lambs, aged 2–3 days, were studied. Continuous esophageal pH-Impedance monitoring and polysomnography were performed for six hours during both spontaneous breathing and nCPAP application at 6 cmH2O (nCPAP6), in a randomized order. Results were compared in the two experimental conditions, as well as without CPAP during the following 6 hours. Results: i) nCPAP6 virtually abolished GER [mean 6SD reflux number for 6 h = 9.168.6 without nCPAP6 vs. 0.661 with nCPAP6, P,0.05]; ii) GER number was also reduced during the 6 h-period following nCPAP6 application (18616 without nCPAP6 vs. 768.1 with nCPAP6, P,0.05); iii) nCPAP6 decreased the depth and duration of lower esophageal sphincter relaxation. Conclusions: nCPAP inhibits GER in the newborn lamb. Further clinical studies using different levels of nasal CPAP are needed to confirm this result in human infants