Laryngeal closure impedes non-invasive ventilation at birth

Jessica R. Crawshaw, Marcus J. Kitchen, Corinna Binder-Heschl, Marta Thio, Megan J. Wallace, Lauren T. Kerr, Charles C. Roehr, Katie L. Lee, Genevieve A. Buckley, Peter G. Davis, Andreas Flemmer, Arjan B. Te Pas, Stuart B. Hooper

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background Non-invasive ventilation is sometimes unable to provide the respiratory needs of very premature infants in the delivery room. While airway obstruction is thought to be the main problem, the site of obstruction is unknown. We investigated whether closure of the larynx and epiglottis is a major site of airway obstruction. Methods We used phase contrast X-ray imaging to visualise laryngeal function in spontaneously breathing premature rabbits immediately after birth and at approximately 1 hour after birth. Non-invasive respiratory support was applied via a facemask and images were analysed to determine the percentage of the time the glottis and the epiglottis were open. Hypothesis Immediately after birth, the larynx is predominantly closed, only opening briefly during a breath, making non-invasive intermittent positive pressure ventilation (iPPV) ineffective, whereas after lung aeration, the larynx is predominantly open allowing non-invasive iPPV to ventilate the lung. Results The larynx and epiglottis were predominantly closed (open 25.5%±1.1% and 17.1%±1.6% of the time, respectively) in pups with unaerated lungs and unstable breathing patterns immediately after birth. In contrast, the larynx and the epiglottis were mostly open (90.5%±1.9% and 72.3%±2.3% of the time, respectively) in pups with aerated lungs and stable breathing patterns irrespective of time after birth. Conclusion Laryngeal closure impedes non-invasive iPPV at birth and may reduce the effectiveness of non-invasive respiratory support in premature infants immediately after birth.

Original languageEnglish
Pages (from-to)F112-F119
Number of pages8
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Volume103
Issue number2
DOIs
Publication statusPublished - 1 Mar 2018

Keywords

  • apnoea
  • glottis
  • larynx
  • Non-invasive ventilation
  • preterm newborn

Cite this

Crawshaw, Jessica R. ; Kitchen, Marcus J. ; Binder-Heschl, Corinna ; Thio, Marta ; Wallace, Megan J. ; Kerr, Lauren T. ; Roehr, Charles C. ; Lee, Katie L. ; Buckley, Genevieve A. ; Davis, Peter G. ; Flemmer, Andreas ; Te Pas, Arjan B. ; Hooper, Stuart B. / Laryngeal closure impedes non-invasive ventilation at birth. In: Archives of Disease in Childhood: Fetal and Neonatal Edition. 2018 ; Vol. 103, No. 2. pp. F112-F119.
@article{f99f9c5e48ed4b3f88276f193986967b,
title = "Laryngeal closure impedes non-invasive ventilation at birth",
abstract = "Background Non-invasive ventilation is sometimes unable to provide the respiratory needs of very premature infants in the delivery room. While airway obstruction is thought to be the main problem, the site of obstruction is unknown. We investigated whether closure of the larynx and epiglottis is a major site of airway obstruction. Methods We used phase contrast X-ray imaging to visualise laryngeal function in spontaneously breathing premature rabbits immediately after birth and at approximately 1 hour after birth. Non-invasive respiratory support was applied via a facemask and images were analysed to determine the percentage of the time the glottis and the epiglottis were open. Hypothesis Immediately after birth, the larynx is predominantly closed, only opening briefly during a breath, making non-invasive intermittent positive pressure ventilation (iPPV) ineffective, whereas after lung aeration, the larynx is predominantly open allowing non-invasive iPPV to ventilate the lung. Results The larynx and epiglottis were predominantly closed (open 25.5{\%}±1.1{\%} and 17.1{\%}±1.6{\%} of the time, respectively) in pups with unaerated lungs and unstable breathing patterns immediately after birth. In contrast, the larynx and the epiglottis were mostly open (90.5{\%}±1.9{\%} and 72.3{\%}±2.3{\%} of the time, respectively) in pups with aerated lungs and stable breathing patterns irrespective of time after birth. Conclusion Laryngeal closure impedes non-invasive iPPV at birth and may reduce the effectiveness of non-invasive respiratory support in premature infants immediately after birth.",
keywords = "apnoea, glottis, larynx, Non-invasive ventilation, preterm newborn",
author = "Crawshaw, {Jessica R.} and Kitchen, {Marcus J.} and Corinna Binder-Heschl and Marta Thio and Wallace, {Megan J.} and Kerr, {Lauren T.} and Roehr, {Charles C.} and Lee, {Katie L.} and Buckley, {Genevieve A.} and Davis, {Peter G.} and Andreas Flemmer and {Te Pas}, {Arjan B.} and Hooper, {Stuart B.}",
year = "2018",
month = "3",
day = "1",
doi = "10.1136/archdischild-2017-312681",
language = "English",
volume = "103",
pages = "F112--F119",
journal = "Archives of Disease in Childhood: Fetal and Neonatal Edition",
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Crawshaw, JR, Kitchen, MJ, Binder-Heschl, C, Thio, M, Wallace, MJ, Kerr, LT, Roehr, CC, Lee, KL, Buckley, GA, Davis, PG, Flemmer, A, Te Pas, AB & Hooper, SB 2018, 'Laryngeal closure impedes non-invasive ventilation at birth', Archives of Disease in Childhood: Fetal and Neonatal Edition, vol. 103, no. 2, pp. F112-F119. https://doi.org/10.1136/archdischild-2017-312681

Laryngeal closure impedes non-invasive ventilation at birth. / Crawshaw, Jessica R.; Kitchen, Marcus J.; Binder-Heschl, Corinna; Thio, Marta; Wallace, Megan J.; Kerr, Lauren T.; Roehr, Charles C.; Lee, Katie L.; Buckley, Genevieve A.; Davis, Peter G.; Flemmer, Andreas; Te Pas, Arjan B.; Hooper, Stuart B.

In: Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol. 103, No. 2, 01.03.2018, p. F112-F119.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Laryngeal closure impedes non-invasive ventilation at birth

AU - Crawshaw, Jessica R.

AU - Kitchen, Marcus J.

AU - Binder-Heschl, Corinna

AU - Thio, Marta

AU - Wallace, Megan J.

AU - Kerr, Lauren T.

AU - Roehr, Charles C.

AU - Lee, Katie L.

AU - Buckley, Genevieve A.

AU - Davis, Peter G.

AU - Flemmer, Andreas

AU - Te Pas, Arjan B.

AU - Hooper, Stuart B.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background Non-invasive ventilation is sometimes unable to provide the respiratory needs of very premature infants in the delivery room. While airway obstruction is thought to be the main problem, the site of obstruction is unknown. We investigated whether closure of the larynx and epiglottis is a major site of airway obstruction. Methods We used phase contrast X-ray imaging to visualise laryngeal function in spontaneously breathing premature rabbits immediately after birth and at approximately 1 hour after birth. Non-invasive respiratory support was applied via a facemask and images were analysed to determine the percentage of the time the glottis and the epiglottis were open. Hypothesis Immediately after birth, the larynx is predominantly closed, only opening briefly during a breath, making non-invasive intermittent positive pressure ventilation (iPPV) ineffective, whereas after lung aeration, the larynx is predominantly open allowing non-invasive iPPV to ventilate the lung. Results The larynx and epiglottis were predominantly closed (open 25.5%±1.1% and 17.1%±1.6% of the time, respectively) in pups with unaerated lungs and unstable breathing patterns immediately after birth. In contrast, the larynx and the epiglottis were mostly open (90.5%±1.9% and 72.3%±2.3% of the time, respectively) in pups with aerated lungs and stable breathing patterns irrespective of time after birth. Conclusion Laryngeal closure impedes non-invasive iPPV at birth and may reduce the effectiveness of non-invasive respiratory support in premature infants immediately after birth.

AB - Background Non-invasive ventilation is sometimes unable to provide the respiratory needs of very premature infants in the delivery room. While airway obstruction is thought to be the main problem, the site of obstruction is unknown. We investigated whether closure of the larynx and epiglottis is a major site of airway obstruction. Methods We used phase contrast X-ray imaging to visualise laryngeal function in spontaneously breathing premature rabbits immediately after birth and at approximately 1 hour after birth. Non-invasive respiratory support was applied via a facemask and images were analysed to determine the percentage of the time the glottis and the epiglottis were open. Hypothesis Immediately after birth, the larynx is predominantly closed, only opening briefly during a breath, making non-invasive intermittent positive pressure ventilation (iPPV) ineffective, whereas after lung aeration, the larynx is predominantly open allowing non-invasive iPPV to ventilate the lung. Results The larynx and epiglottis were predominantly closed (open 25.5%±1.1% and 17.1%±1.6% of the time, respectively) in pups with unaerated lungs and unstable breathing patterns immediately after birth. In contrast, the larynx and the epiglottis were mostly open (90.5%±1.9% and 72.3%±2.3% of the time, respectively) in pups with aerated lungs and stable breathing patterns irrespective of time after birth. Conclusion Laryngeal closure impedes non-invasive iPPV at birth and may reduce the effectiveness of non-invasive respiratory support in premature infants immediately after birth.

KW - apnoea

KW - glottis

KW - larynx

KW - Non-invasive ventilation

KW - preterm newborn

UR - http://www.scopus.com/inward/record.url?scp=85041063636&partnerID=8YFLogxK

U2 - 10.1136/archdischild-2017-312681

DO - 10.1136/archdischild-2017-312681

M3 - Article

VL - 103

SP - F112-F119

JO - Archives of Disease in Childhood: Fetal and Neonatal Edition

JF - Archives of Disease in Childhood: Fetal and Neonatal Edition

SN - 1359-2998

IS - 2

ER -