title: Development of pharyngo-esophageal physiology during swallowing in the preterm infant.
abstract: BACKGROUND
  Poor feeding is a common cause of prolonged hospitalization of preterm infants. Pharyngeal and upper esophageal sphincter (UES) function of preterm infants has been technically difficult to assess and is therefore poorly characterized. The aim of this study was to assess the development of pharyngeal motility, UES function, and their coordination during nutritive swallowing in preterm infants.
  
  
  METHODS
  Development of swallowing was assessed in 18 preterm infants. High resolution manometry was performed at first oral feeding attempt (31-32 week) and then weekly for 4 weeks. Pharyngeal and UES pressure changes were characterized in 980 swallows.
  
  
  RESULTS
  During swallowing, we observed an age-related increase in peak pharyngeal pressure at the laryngeal inlet (1 cm above UES) but an age-related decrease in the time required for the UES to fully relax to nadir. Analysis of the timing of proximal pharyngeal contractile peak and UES nadir showed that the UES was not fully relaxed when bolus propulsive forces were at their peak in the youngest infants.
  
  
  CONCLUSIONS
  Results show developmental changes in infant swallow physiology that can be clearly linked to the effectiveness of nutritive swallowing. Most preterm infants demonstrated poor pharyngeal pressures at the laryngeal inlet coupled with poor coordination of pharyngeal propulsion with UES relaxation. These pressure patterns were less efficient than those demonstrated by older infants who were more adept at feeding. These observations may explain why infants under 34 weeks are physiologically unable to feed effectively and experience frequent choking and fatigue during feeding.
authors.affiliation: Centre for Pediatric & Adolescent Gastroenterology, Children, Youth & Women's Health Service, Women's and Children's Hospital, North Adelaide (SA), Australia. nathalie.rommel@med.kuleuven.be
authors.forename: N
authors.initials: N
authors.lastname: Rommel
authors.forename: M
authors.initials: M
authors.lastname: van Wijk
authors.forename: B
authors.initials: B
authors.lastname: Boets
authors.forename: G
authors.initials: G
authors.lastname: Hebbard
authors.forename: R
authors.initials: R
authors.lastname: Haslam
authors.forename: G
authors.initials: G
authors.lastname: Davidson
authors.forename: T
authors.initials: T
authors.lastname: Omari
mesh_terms: D003679:Deglutition / Q000502:physiology*; D049631:Esophageal Sphincter, Upper / Q000254:growth & development / Q000502:physiology*; D004947:Esophagus / Q000254:growth & development / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008365:Manometry; D010614:Pharynx / Q000254:growth & development / Q000502:physiology*; D047928:Premature Birth