Jeffery H E, Ius D, Page M
Department of Neonatal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
J Pediatr. 2000 Oct;137(4):545-8. doi: 10.1067/mpd.2000.108121.
To investigate swallowing and peristalsis in sleep and during gastroesophageal reflux (GER) in both healthy term and preterm infants at term equivalent age.
Multichannel recordings were made in 12 healthy term and 11 preterm infants, under the same conditions, after feeding. Sleep state, cardiorespiratory variables, esophageal pH, and pharyngeal swallowing and peristalsis were measured. GER was defined as pH <4 for > or = 15 seconds, and swallows were classified as pharyngeal only, primary peristalsis (propagated, dropped, interrupted), or secondary peristalsis.
Spontaneous swallowing rate was not significantly different between term and preterm infants and was sleep state-related, occurring in active sleep but rarely in quiet sleep. In response to acid GER, term infants significantly increased pharyngeal swallowing from a median of 0.7 (25th-75th interquartile range, 0.5-0.9) to 1.7 (1.0-3.0) swallows/min and secondary peristalsis from a median of 0.5 (25th-75th interquartile range, 0.3-0.8) to 1.1 (0.8-2.0) waves/min (P <.05). In contrast, the preterm infants demonstrated a significantly higher proportion of fully propagated peristaltic swallows compared with the term infants (53% and 27%, respectively) (P <.05).
The occurrence of swallowing is sleep state-related. In active sleep, term infants clear GER by increasing swallowing and secondary peristalsis, whereas preterm infants at term equivalent age clear GER by increasing propagated peristalsis. This method of clearance would explain the mechanism by which preterm infants have significantly shorter episodes of reflux than term infants.
研究足月健康婴儿和足月时的早产婴儿在睡眠及胃食管反流（GER）期间的吞咽和蠕动情况。
对12名足月健康婴儿和11名早产婴儿在相同条件下喂食后进行多通道记录。测量睡眠状态、心肺变量、食管pH值以及咽部吞咽和蠕动情况。GER定义为pH值<4持续≥15秒，吞咽分为仅咽部吞咽、原发性蠕动（传播性、掉落性、中断性）或继发性蠕动。
足月婴儿和早产婴儿的自发吞咽率无显著差异，且与睡眠状态相关，发生于主动睡眠时，但在安静睡眠时很少发生。对于酸性GER，足月婴儿咽部吞咽从中位数0.7（第25至75四分位间距，0.5 - 0.9）显著增加至1.7（1.0 - 3.0）次/分钟，继发性蠕动从中位数0.5（第25至75四分位间距，0.3 - 0.8）增加至1.1（0.8 - 2.0）次/分钟（P <.05）。相比之下，早产婴儿完全传播性蠕动吞咽的比例显著高于足月婴儿（分别为53%和27%）（P <.05）。
吞咽的发生与睡眠状态相关。在主动睡眠中，足月婴儿通过增加吞咽和继发性蠕动清除GER，而足月时的早产婴儿通过增加传播性蠕动清除GER。这种清除方式可以解释早产婴儿反流发作时间明显短于足月婴儿的机制。
