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Swallow Safety is Determined by Bolus Volume During Infant Feeding in an Animal Model

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Abstract

Feeding difficulties are especially prevalent in preterm infants, although the mechanisms driving these difficulties are poorly understood due to a lack of data on healthy infants. One potential mechanism of dysphagia in adults is correlated with bolus volume. Yet, whether and how bolus volume impacts swallow safety in infant feeding is unknown. A further complication for safe infant swallowing is recurrent laryngeal nerve (RLN) injury due to patent ductus arteriosus surgery, which exacerbates the issues that preterm infants face and can increase the risk of dysphagia. Here, we used a validated animal model feeding freely to test the effect of preterm birth, postnatal maturation and RLN lesion and their interactions on swallow safety. We also tested whether bolus size differed with lesion or birth status, and the relationship between bolus size and swallow safety. We found very little effect of lesion on swallow safety, and preterm infants did not experience more penetration or aspiration than term infants. However, term infants swallowed larger boluses than preterm infants, even after correcting for body size. Bolus size was the primary predictor of penetration or aspiration, with larger boluses being more likely to result in greater degrees of dysphagia irrespective of age or lesion status. These results highlight that penetration and aspiration are likely normal occurrences in infant feeding. Further, when comorbidities, such as RLN lesion or preterm birth are present, limiting bolus size may be an effective means to reduce incidences of penetration and aspiration.

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Acknowledgements

We would like to thank C. Tennant and E. Catchpole for their assistance with data collection and animal care, Claire Lewis, Katlyn McGrattan and Kayla Hernandez for assistance with animal care, and the Biomechanics journal club at NEOMED for their helpful comments on an earlier version of this manuscript.

Funding

This project was funded by NIH R01 HD088561 to R.Z.G.

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Authors and Affiliations

  1. Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, 44272, USA

    Christopher J. Mayerl, Alexis M. Myrla, Laura E. Bond, Bethany M. Stricklen & Rebecca Z. German

  2. Department of Cell Biology and Neuroscience, Rowan School of Osteopathic Medicine, Stratford, NJ, USA

    Francois D. H. Gould

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  1. Christopher J. Mayerl
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  2. Alexis M. Myrla
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  3. Francois D. H. Gould
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Contributions

Study Design: CJM, FDHG, RZG. Data collection: All authors Data processing: CJM and AMM. Data analysis: CJM Wrote Manuscript: CJM and AMM Edited manuscript: RZG and FDHG, Approved manuscript for publication: all authors.

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Correspondence to Christopher J. Mayerl.

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Mayerl, C.J., Myrla, A.M., Gould, F.D.H. et al. Swallow Safety is Determined by Bolus Volume During Infant Feeding in an Animal Model. Dysphagia 36, 120–129 (2021). https://doi.org/10.1007/s00455-020-10118-x

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