title: Mechanisms of cough provocation and cough resolution in neonates with bronchopulmonary dysplasia.
abstract: BACKGROUND
  Cough and deglutition are protective mechanisms that defend against aspiration. We identified mechanisms associated with cough provocation as well as those associated with cough resolution in infants with bronchopulmonary dysplasia (BPD).
  
  
  METHODS
  Manometry signatures of cough were recognized in 16 premature infants with BPD undergoing concurrent esophageal manometry, respiratory inductance plethysmography, and nasal air flow measurements. Pretussive and post-tussive pharyngo-esophageal motility changes were analyzed. Mechanisms associated with cough and mechanisms that restored respiratory and esophageal normalcy were analyzed.
  
  
  RESULTS
  We analyzed 312 cough events during 88 cough clusters; 97% were associated with recognizable manometric patterns. Initial mechanisms related with coughing included nonpropagating swallow (59%), upper esophageal sphincter (UES) reflex contraction (18%), and lower esophageal sphincter (LES) relaxation (14%). UES and LES dysfunction was present in 69% of nonpropagating swallow-associated cough clusters. Mechanisms restoring post-tussive normalcy included primary peristalsis (84%), secondary peristalsis (8%), and none recognized (8%). UES contraction reflex was associated with cough clusters more frequently in infants on nasal continuous positive airway pressure (NCPAP) (OR = 9.13, 95% CI = 1.88-44.24).
  
  
  CONCLUSIONS
  Cough clusters in infants with BPD had identifiable etiologies associated with esophageal events; common initial mechanisms were of upper aerodigestive origin, while common clearing mechanisms were peristaltic reflexes.
authors.affiliation: The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Nationwide Children's Hospital Research Institute, Columbus, Ohio.|The Neonatal Aerodigestive Pulmonary Program, Nationwide Children's Hospital, Columbus, Ohio.|Divisions of Neonatology, Pediatric Gastroenterology and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Sudarshan R
authors.initials: SR
authors.lastname: Jadcherla
authors.affiliation: The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Nationwide Children's Hospital Research Institute, Columbus, Ohio.|The Neonatal Aerodigestive Pulmonary Program, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Hasenstab
authors.affiliation: Gastroenterology and Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Reza
authors.initials: R
authors.lastname: Shaker
authors.affiliation: The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Nationwide Children's Hospital Research Institute, Columbus, Ohio.|The Neonatal Aerodigestive Pulmonary Program, Nationwide Children's Hospital, Columbus, Ohio.|Division of Respiratory Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Castile
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D016009:Chi-Square Distribution; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects; D003371:Cough / Q000209:etiology* / Q000503:physiopathology; D003679:Deglutition; D015154:Esophageal Motility Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004947:Esophagus / Q000294:innervation*; D005260:Female; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008365:Manometry; D015999:Multivariate Analysis; D016017:Odds Ratio; D010528:Peristalsis; D010614:Pharynx / Q000294:innervation; D011312:Pressure; D012018:Reflex; D012307:Risk Factors; D013997:Time Factors