title: Effect of nasal noninvasive respiratory support methods on pharyngeal provocation-induced aerodigestive reflexes in infants.
abstract: The pharynx is a locus of provocation among infants with aerodigestive morbidities manifesting as dysphagia, life-threatening events, aspiration-pneumonia, atelectasis, and reflux, and such infants often receive nasal respiratory support. We determined the impact of different oxygen delivery methods on pharyngeal stimulation-induced aerodigestive reflexes [room air (RA), nasal cannula (NC), and nasal continuous positive airway pressure (nCPAP)] while hypothesizing that the sensory motor characteristics of putative reflexes are distinct. Thirty eight infants (28.0 ± 0.7 wk gestation) underwent pharyngoesophageal manometry and respiratory inductance plethysmography to determine the effects of graded pharyngeal stimuli (n = 271) on upper and lower esophageal sphincters (UES, LES), swallowing, and deglutition-apnea. Comparisons were made between NC (n = 19), nCPAP (n = 9), and RA (n = 10) groups. Importantly, NC or nCPAP (vs. RA) had: 1) delayed feeding milestones (P < 0.05), 2) increased pharyngeal waveform recruitment and duration, greater UES nadir pressure, decreased esophageal contraction duration, decreased distal esophageal contraction amplitude, and decreased completely propagated esophageal peristalsis (all P < 0.05), and 3) similarly developed UES contractile and LES relaxation reflexes (P > 0.05). We conclude that aerodigestive reflexes were similarly developed in infants using noninvasive respiratory support with adequate upper and lower aerodigestive protection. Increased concern for GERD is unfounded in this population. These infants may benefit from targeted oromotor feeding therapies and safe pharyngeal bolus transit to accelerate feeding milestones.
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, Department of Pediatrics; The Ohio State University College of Medicine, Columbus, Ohio; and Sudarshan.Jadcherla@nationwidechildrens.org.
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: The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Nationwide Children's Hospital Research Institute, Columbus Ohio;
authors.forename: Swetha
authors.initials: S
authors.lastname: Sitaram
authors.affiliation: The Neonatal Aerodigestive Pulmonary Program, Nationwide Children's Hospital, Columbus, Ohio;
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Clouse
authors.affiliation: Divisions of Neonatology, Department of Pediatrics; The Ohio State University College of Medicine, Columbus, Ohio; and.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Slaughter
authors.affiliation: Gastroenterology and Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Reza
authors.initials: R
authors.lastname: Shaker
mesh_terms: D016022:Case-Control Studies; D003679:Deglutition; D004947:Esophagus / Q000502:physiology*; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature / Q000502:physiology*; D007231:Infant, Newborn; D008297:Male; D063087:Noninvasive Ventilation / Q000009:adverse effects* / Q000379:methods; D010528:Peristalsis; D010614:Pharynx / Q000502:physiology*; D010991:Plethysmography; D012018:Reflex; D012119:Respiration
keywords: bronchopulmonary dysplasia, neonate