UES NEONATES.docx
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UES NEONATES.docx
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UESNEONATES
JPediatr.2007December;151(6):
597–603.
PHARYNGEALSWALLOWING:
DEFININGPHARYNGEALANDUPPERESOPHAGEALSPHINCTERRELATIONSHIPSINHUMANNEONATES
SudarshanRaoJadcherla,MD,FRCPI,DCH,1AlankarGupta,MD,MS,2ErinStoner,RN,BSN,2SoledadFernandez,PhD,3andRezaShaker,MD4
1SectionsofNeonatology,PediatricGastroenterologyandNutritionattheColumbusChildren’sHospital,DepartmentofPediatricsatTheOhioStateUniversityCollegeofMedicineandPublicHealth,700Children’sDrive,Columbus,OH43205
2SectionofNeonatology,ColumbusChildren’sHospital,700Children’sDrive,Columbus,OH43205
3CenterforBiostatisticsatTheOhioStateUniversityCollegeofMedicineandPublicHealth,ColumbusChildren’sResearchInstitute,700Children’sDrive,Columbus,OH43205
4DivisionofGastroenterologyandHepatology,DepartmentofInternalMedicine,andDysphagiaInstitute,MedicalCollegeofWisconsin,8701WatertownPlankRd,Milwaukee,WI53226
CORRESPONDINGAUTHOR:
SudarshanR.Jadcherla,MD,FRCPI,DCH,SectionofNeonatology,700Children’sDrive,ColumbusChildren’sHospital,Columbus,OH43205.Email:
jadcherlas@pediatrics.ohio-state.edu,Telephone:
(614)722-4428,Fax:
(614)722-4541
Abstract
Objective
Totestthehypothesisthatthesensory-motorcharacteristicsofthereflexesevokeduponstimulationwithairandwaterinfusionsdiffer,westudiedtheeffectofpharyngealstimulationonthepharyngeal-upperesophagealsphincter(UES)interactionsinhealthyneonates
Studydesign
Pharyngo-UES-esophagealmanometrywasrecordedin10neonatesat39±4wkpostmenstrualage.Pharyngealinfusions(n=155)ofair(0.1–2.0ml)andsterilewater(0.1–0.5ml)weregiven.Twotypesofreflexeswererecognized:
Pharyngealreflexiveswallowing(PRS)andpharyngo-UES-contractilereflex(PUCR).Frequencyoccurrence,distributionofreflexes,thresholdvolume,responsetime,andstimulus-responserelationshipwereevaluated.
Results
Thereflexresponserateforairwas30%andwas76%forwater(P<0.001).ThefrequencyoccurrenceofPRSwasgreaterthanPUCRwithairandwater(P<0.05),althoughthestimulationthresholdsandresponselatencyweresimilar.GradedvolumesofwaterbutnotairresultedinanincreasedfrequencyofPRS(P<0.01).
Conclusions
PRSisthemostfrequentresponse,andcharacteristicsofthereflexesaredistinctbetweenairvs.waterstimuli.Thesemethodshaveimplicationsfortheevaluationofswallowingininfants.
Keywords:
Pharyngealreflexiveswallowing,upperesophagealsphincter,pharyngo-UES-contractilereflex,neonates
Swallowingactivityappearsinthefetallifearound11weeksgestation,1andsuckingandswallowingskillsdevelopprogressivelyduringfetalandneonatalmaturation.2,3Thesurvivalrateamongpretermneonatesisincreasing,andoneofthereasonsforprolongedhospitalizationisahighprevalenceofswallowingdifficulty.4
Previousstudiesininfantsandchildrenhaveaddressedthepreparatoryandoralphasesofswallow,1,5,6pharyngealphaseofswallowandrelationshipwithsleepandbreathing,7–9andupperesophagealsphincter(UES)motorfunction.10–12Theintegratedrelationshipbetweentheswallowingphaseshasnotbeensystematicallyinvestigatedinneonates.Usingmanometricmethods,wecharacterizedtheUEScontractileandrelaxationpropertiesduringspontaneousswallowinducedprimaryperistalsissequencesacrosstheagespectrum,fromhealthyprematureinfantstoadultvolunteers.13However,UESresponsesinduceduponpharyngealstimulationhavenotbeendescribedinneonates.
Thepharynxisthesiteofconstantstimulationduringbreathing,duringbolusoralfeeding,orduringgastro-esophago-pharyngealrefluxevents.Theneonatalaerodigestivetractisacommonsitemanipulatedacutely(asinapparentlifethreateningevents),orchronically(asinassistedrespirationorassistedenteralnutrition).Therefore,therationaleforthisinvestigationwastoevaluatetheimmediateresponsesresultingfrompharyngealstimulationinthepopulationthatreceivedneonatalICUcare.Theprimaryobjectivesofourstudyweretodefinethefrequencyofoccurrenceandtoelucidatethecharacteristicsofpharyngeal–UESreflexinteractionseliciteduponpharyngealprovocationtoorallyfeedinginprematurelybornhealthyhumanneonates.Wetestedthehypothesisthatpharyngealstimulationwithairandwaterinfusionsresultindistinctneuromotorresponses.
METHODS
Participants
Eligiblesubjectswereorallyfeedinghealthyprematurelybornneonateswithappropriategrowthatbirthandatstudy.Gestationalage(GA)amonginfantswasdeterminedbymaternalhistoryandobstetricdata.Postmenstrualage(PMA)wascalculatedbyaddingchronologicalagetoGA.Allinfantswereexaminedbytheprincipalinvestigator(SRJ),aswellastheattendingneonatologist,andweredeemedhealthyatstudy.Noneofthein
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