title: Esophageal sensation in premature human neonates: temporal relationships and implications of aerodigestive reflexes and electrocortical arousals.
abstract: Electrocortical arousal (ECA) as an effect of visceral provocation or of its temporal relationships with aerodigestive reflexes in premature neonates is not known. We tested the hypothesis that esophageal provocation results in both esophageal reflex responses and ECAs during sleep and that ECAs are dependent on the frequency characteristics of esophageal neuromotor responses. We defined the spatiotemporal relationship of ECAs in relation to 1) spontaneous pharyngoesophageal swallow sequences and gastroesophageal reflux (GER) events and 2) sensory-motor characteristics of esophageal reflexes. Sixteen healthy premature neonates born at 27.9 ± 3.4 wk were tested at 36.8 ± 1.9 wk postmenstrual age. Ninety-five midesophageal and 31 sham stimuli were given in sleep during concurrent manometry and videopolysomnography. With stimulus onset as reference point, we scored the response latency, frequency occurrence and duration of arousals, peristaltic reflex, and upper esophageal sphincter contractile reflex (UESCR). Changes in polysomnography-respiratory patterns and esophageal sensory-motor parameters were scored by blinded observers. Significantly (for each characteristic listed, P < 0.05), swallow sequences were associated with arousals and sleep state changes, and arousals were associated with incomplete peristalsis, response delays to lower esophageal sphincter relaxation, and prolonged esophageal clearance. GER events (73.5%) provoked arousals, and arousals were associated with response delays to peristaltic reflexes or clearance, sleep state modification, and prolonged respiratory arousal. Midesophageal stimuli (54%) provoked arousals and were associated with increased frequency, prolonged latency, prolonged response duration of peristaltic reflexes and UESCR, and increased frequency of sleep state changes and respiratory arousals. In human neonates, ECAs are provoked upon esophageal stimulation; the sensory-motor characteristics of esophageal reflexes are distinct when accompanied by arousals. Aerodigestive homeostasis is defended by multiple tiers of aerodigestive safety mechanisms, and when esophageal reflexes are delayed, cortical hypervigilance (ECAs) occurs.
authors.affiliation: Sections of Neonatology, Pediatric Gastroenterology, and Nutrition, The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Department of Pediatrics, The Ohio State University College of Medicine, The Research Institute at Nationwide Children's Hospital, Columbus 43205, USA. Sudarshan.Jadcherla@Nationwidechildrens.org
authors.forename: Sudarshan R
authors.initials: SR
authors.lastname: Jadcherla
authors.forename: Vanessa N
authors.initials: VN
authors.lastname: Parks
authors.forename: Juan
authors.initials: J
authors.lastname: Peng
authors.forename: Samuel
authors.initials: S
authors.lastname: Dzodzomenyo
authors.forename: Soledad
authors.initials: S
authors.lastname: Fernandez
authors.forename: Reza
authors.initials: R
authors.lastname: Shaker
authors.forename: Mark
authors.initials: M
authors.lastname: Splaingard
mesh_terms: D001143:Arousal / Q000502:physiology*; D002540:Cerebral Cortex / Q000502:physiology*; D003679:Deglutition / Q000502:physiology; D004947:Esophagus / Q000502:physiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D010528:Peristalsis / Q000502:physiology; D011930:Reaction Time / Q000502:physiology; D012018:Reflex / Q000502:physiology*; D012890:Sleep / Q000502:physiology