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Maturation Modulates Pharyngeal-Stimulus Provoked Pharyngeal and Respiratory Rhythms in Human Infants

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Abstract

Pharyngeal-provocation induced aerodigestive symptoms in infants remain an enigma. Sources of pharyngeal provocation can be anterograde as with feeding, and retrograde as in gastroesophageal reflux. We determined maturational and dose–response effects of targeted pharyngeal-stimulus on frequency, stability, and magnitude of pharyngeal and respiratory waveforms during multiple pharyngeal swallowing responses in preterm-born infants when they were of full-term postmenstrual age (PMA). Eighteen infants (11 male) were studied longitudinally at 39.8 ± 4.8 weeks PMA (time-1) and 44.1 ± 5.8 weeks PMA (time-2). Infants underwent concurrent pharyngo-esophageal manometry, respiratory inductance plethysmography, and nasal airflow thermistor methods to test sensory-motor interactions between the pharynx, esophagus, and airway. Linear mixed models were used and data presented as mean ± SEM or %. Overall, responses to 250 stimuli were analyzed. Of the multiple pharyngeal swallowing responses (n = 160), with maturation (a) deglutition apnea duration decreases (p < 0.01), (b) number of pharyngeal waveform peaks and duration decreases for initial responses (p < 0.01), and subsequent responses have lesser variation and greater stability (p < 0.01). With increment in stimulus volumes we noted (a) increased prevalence (%) of pharyngeal responses (p < 0.05), (b) increased number of pharyngeal peaks (p < 0.05), yet pharyngeal frequency (Hz), variability, and stability remain unaffected (p > 0.05), and (c) respiratory changes were unaffected (p > 0.05). Initial and subsequent pharyngeal responses and respiratory rhythm interactions become more distinct with maturation. Interval oromotor experiences and volume-dependent increase in adaptive responses may be contributory. These mechanisms may be important in modulating and restoring respiratory rhythm normalcy.

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Abbreviations

UES:

Upper esophageal sphincter

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Acknowledgements

The authors are grateful to Brittany Durr, RN, BSN, MHA, for clinical nursing coordination and Lai Wei, PhD for statistical modeling, analysis, and verification.

Funding

This study is supported in part by National Institutes of Health Grants 2R01DK068158 and P01DK068051.

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Authors and Affiliations

  1. The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Nationwide Children’s Hospital Research Institute, Columbus, OH, USA

    Kathryn A. Hasenstab, Swetha Sitaram & Sudarshan R. Jadcherla

  2. Divisions of Neonatology, Pediatric Gastroenterology and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA

    Sudarshan R. Jadcherla

  3. Dysphagia Animal Research Laboratory, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA

    Ivan M. Lang

  4. Division of Gastroenterology and Hepatology and Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Reza Shaker

  5. Divisions of Neonatology, Pediatric Gastroenterology and Nutrition, Innovative Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH, 43215, USA

    Sudarshan R. Jadcherla

Authors
  1. Kathryn A. Hasenstab
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  2. Swetha Sitaram
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Correspondence to Sudarshan R. Jadcherla.

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Hasenstab, K.A., Sitaram, S., Lang, I.M. et al. Maturation Modulates Pharyngeal-Stimulus Provoked Pharyngeal and Respiratory Rhythms in Human Infants. Dysphagia 33, 63–75 (2018). https://doi.org/10.1007/s00455-017-9833-z

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  • DOI: https://doi.org/10.1007/s00455-017-9833-z

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