Esophageal reflexes modulate frontoparietal response in neonates: Novel application of concurrent NIRS and provocative esophageal manometry.
Central and peripheral neural regulation of swallowing and aerodigestive reflexes is unclear in human neonates. Functional near infrared spectroscopy (NIRS) is a noninvasive method to measure changes in oxyhemoglobin (HbO) and deoxyhemoglobin (HbD). Pharyngoesophageal manometry permits evaluation of aerodigestive reflexes. Modalities were combined to investigate feasibility and to test neonatal frontoparietal cortical changes during pharyngoesophageal (visceral) stimulation and/or swallowing. Ten neonates (45.6 ± 3.0 wk postmenstrual age, 4.1 ± 0.5 kg) underwent novel pharyngoesophageal manometry concurrent with NIRS. To examine esophagus-brain interactions, we analyzed cortical hemodynamic response (HDR) latency and durations during aerodigestive provocation and esophageal reflexes. Data are presented as means ± SE or percent. HDR rates were 8.84 times more likely with basal spontaneous deglutition compared with sham stimuli (P = 0.004). Of 182 visceral stimuli, 95% were analyzable for esophageal responses, 38% for HDR, and 36% for both. Of analyzable HDR (n = 70): 1) HbO concentration (μmol/l) baseline 1.5 ± 0.7 vs. 3.7 ± 0.7 poststimulus was significant (P = 0.02), 2) HbD concentration (μmol/l) between baseline 0.1 ± 0.4 vs. poststimulus -0.5 ± 0.4 was not significant (P = 0.73), and 3) hemispheric lateralization was 21% left only, 29% right only, and 50% bilateral. During concurrent esophageal and NIRS responses (n = 66): 1) peristaltic reflexes were present in 74% and HDR in 61% and 2) HDR was 4.75 times more likely with deglutition reflex vs. secondary peristaltic reflex (P = 0.016). Concurrent NIRS with visceral stimulation is feasible in neonates, and frontoparietal cortical activation is recognized. Deglutition contrasting with secondary peristalsis is related to cortical activation, thus implicating higher hierarchical aerodigestive protective functional neural networks.
Divisions of Neonatology and Pediatric Gastroenterology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; sudarshan.jadcherla@nationwidechildrens.org.
Sudarshan R
SR
Jadcherla
Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio.
Joanna F
JF
Pakiraih
Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio;
Kathryn A
KA
Hasenstab
Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Biomedical, Industrial & Human Factors Engineering, Wright State University, Ohio; and.
Irfaan
I
Dar
Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio;
Xiaoyu
X
Gao
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio.
D Gregory
DG
Bates
Biomedical, Industrial & Human Factors Engineering, Wright State University, Ohio; and.
Nasser H
NH
Kashou
D015415:Biomarkers / Q000097:blood; D002560:Cerebrovascular Circulation; D003679:Deglutition; D004947:Esophagus / Q000294:innervation*; D005240:Feasibility Studies; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply*; D007839:Functional Laterality; D005865:Gestational Age; D006439:Hemodynamics; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008365:Manometry; D010108:Oxyhemoglobins / Q000378:metabolism; D010296:Parietal Lobe / Q000098:blood supply*; D010528:Peristalsis; D011312:Pressure; D012018:Reflex; D019265:Spectroscopy, Near-Infrared
D015415:Biomarkers; D006454:Hemoglobins; D010108:Oxyhemoglobins; C100003:deoxyhemoglobin
aerodigestive reflexes; esophageal motility; near infrared spectroscopy; swallowing; visceral sensation