Upper airways and neonatal respiration

The upper airways exert an important influence on breathing from the fetal period onward. This review focuses on recent results obtained in the newborn, particularly on laryngeal function in the lamb. Cumulated data can be summarized as follows. Firstly, upper airway closure, either at the pharyngeal or laryngeal level, is now known to occur during central apneas. By maintaining a high apneic lung volume throughout central apneas, active laryngeal closure decreases the magnitude of post-apneic desaturation. Secondly, reflexes originating from laryngeal mucosal receptors, such as laryngeal chemoreflexes and non-nutritive swallowing, are of crucial importance within the context of preterm birth, postnatal maturation, neonatal apneas and apparent life-threatening events/sudden infant death syndrome. While laryngeal chemoreflexes appear to be mature and confer an efficient protection against aspiration in the full-term healthy newborn, they can be responsible for prolonged apneas and bradycardias in the immature preterm newborn. In regard to non-nutritive swallowing, the absence of swallowing activity during apneas in periodic breathing during quiet sleep as well as the presence of bursts of swallows with apneas in active sleep remain to be explained. Forthcoming studies will have to further delineate the impact of common clinical conditions, such as cigarette smoke exposure and/or viral respiratory infection on laryngeal chemoreflexes and non-nutritive swallowing. Better knowledge on the importance of the upper airways in neonatal respiration will ultimately aid in designing clinical applications for the understanding and treatment of severe, pathological respiratory conditions of the newborn.