title: Effects of pacifier and taste on swallowing, esophageal motility, transit, and respiratory rhythm in human neonates.
abstract: BACKGROUND
  Pacifier use is widely prevalent globally despite hygienic concerns and uncertain mechanistic effects on swallowing or airway safety.
  
  
  OBJECTIVE
  The effects of pacifier and taste interventions on pharyngo-esophageal motility, bolus transit, and respiratory rhythms were investigated by determining the upper esophageal sphincter (UES), esophageal body, esophagogastric junction (EGJ) motor patterns and deglutition apnea, respiratory rhythm disturbances, and esophageal bolus clearance.
  
  
  METHODS
  Fifteen infants (six males; median gestation 31 weeks and birth weight 1.4 kg) underwent high-resolution impedance manometry at 43 (41-44) weeks postmenstrual age. Manometric, respiratory, and impedance characteristics of spontaneous swallows, pacifier-associated dry swallowing and taste (pacifier dipped in 3% sucrose)-associated swallowing were analyzed. Linear mixed and generalized estimating equation models were used. Data are presented as mean ± SEM, %, or median (IQR).
  
  
  RESULTS
  Pharyngo-esophageal motility, respiratory, and impedance characteristics of 209 swallows were analyzed (85 spontaneous swallows, 63 pacifier- swallows, 61 taste- swallows). Basal UES and EGJ pressures decreased upon pacifier (p < 0.05) and taste interventions (p < 0.05); however, esophageal motility, respiratory rhythm, and impedance transit characteristics were similar with both interventions.
  
  
  CONCLUSIONS
  Oral stimulus with pacifier or taste interventions decreases UES and EGJ basal pressure, but has no effects on pharyngo-esophageal motility, airway interactions, or esophageal bolus transit. A decrease in central parasympathetic-cholinergic excitatory drive is likely responsible for the basal effects.
authors.affiliation: Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Shubert
authors.affiliation: Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sitaram
authors.affiliation: Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA.|Division of Pediatric Gastroenterology and Nutrition, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Jadcherla
mesh_terms: D003679:Deglutition; D017097:Electric Impedance; D004947:Esophagus / Q000502:physiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008365:Manometry; D041361:Pacifiers; D010528:Peristalsis / Q000502:physiology; D010614:Pharynx / Q000502:physiology; D012119:Respiration; D013649:Taste / Q000502:physiology*
keywords: esophageal pressure topography; esophagogastric junction; high-resolution impedance manometry; upper esophageal sphincter