PERIPHERAL BLOOD FLOW DURING CONTINUOUS POSITIVE AIRWAY PRESSURE BREATHING (CPAP) IN TERM NEONATES

Abstract

CPAP in adults impairs venous return, and decreases cardiac output and peripheral perfusion. These circulatory changes are generally demonstrable with pressures greater than those employed for neonatal respiratory conditions. We have measured peripheral blood flow in spontaneously breathing infants with CPAP levels that are used clinically.

We studied eight term newborns < one week of age, whose cardio-respiratory systems were normal. CPAP was administered by face mask. Intra-esophageal pressure (IEP - balloon catheter) and leg blood flow (Q₁ - venous occlusion plethysmography) were measured before and during CPAP. Studies were carried out in the infants' incubators at least two hours after feeding.

The mean increase in peak expiratory IEP was 2.14 ± 1.0 cm H₂O compared to the mean applied CPAP of 7.93 ± 1.0 cm H₂O. This 74% attenuation is similar to that reported in infants with RDS treated by CPAP. Q₁ at atmospheric pressure 8.1 ± 3.0 ml/100 ml/min, and during CPAP was 7.6 ± 3.6 ml/100 ml/ min, an insignificant change (paired T = 0.58, p < 0.50).

We conclude that moderate levels of CPAP, similar to levels employed clinically, do not impair leg blood flow in term newborns.

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