[André Bullinger's contributions to the management of prematurity in neonatology]

Between 30 and 50 % of very premature babies have disorders that can affect their schooling, training and future life. Their origin is often multifactorial, and environmental, socioeconomic and family factors can influence the subsequent development of these children. Among these factors, the neonatal environment, which is generally very noisy and bright, as well as the numerous tactile solicitations, have been blamed. In 1978, the kangaroo method transformed this reality by improving the parent-baby relationship and reducing neonatal mortality. Since then, a trend has developed around developmental care with the Neonatal Individualized Developmental Care Assessment Program and the approach of André Bullinger.

[Giving meaning to the feeding of the premature newborn by nasogastric tube]

The feeding of the premature infant, even when this is done by gastric tube, should be a moment of sharing. However, the way care is normally organised and at times the availability of the parents turn the process into something the baby passively endures. But an enteral nutrition by tube feeding in the arms of the parents who push the feeding syringe by hand reveals a benefit for the premature newborn and the parents.

Absence of effect of nasal continuous positive airway pressure on the esophageal phase of nutritive swallowing in newborn lambs

OBJECTIVES

It is presently recommended that oral feeding be started in premature infants as soon as possible, often at an age at which nasal continuous positive airway pressure (nCPAP) is still required for ventilatory support. Our previous data showed that application of nCPAP up to 10 cmH2O in full-term lambs had no deleterious effect on cardiorespiratory safety, feeding efficiency, or on nutritive swallowing-breathing coordination. Besides fear of swallowing-breathing coordination disturbances, esophageal motility disruption by nCPAP could be a reason to delay oral feeding. To our knowledge, no study has focused on the effects of nCPAP on esophageal motility in the neonatal period. The aim of the present study was therefore to further assess the effects of nCPAP on oral feeding by assessing its effects on the esophageal phase of nutritive swallowing (nutritive esophagodeglutition).

METHODS

Six full-term lambs, ages 2 to 3 days, underwent esophageal multichannel intraluminal impedance-pH monitoring. Lambs were bottle-fed under 2 randomized conditions, namely spontaneous breathing and nCPAP 6 cmH(2)O.

RESULTS

Beyond confirmation of unaltered feeding efficiency, analysis of multiple variables measured by impedance monitoring revealed that nCPAP 6 does not alter nutritive esophagodeglutition in any way (nCPAP vs spontaneous breathing, P > 0.1 for all variables).

CONCLUSIONS

offering further support to neonatologists pleading for initiation of oral feeding in infants still on nCPAP, the present results set the foundations for similar clinical studies in preterm human infants to confirm the absence of effects of nCPAP on nutritive swallowing.