Gewolb I H, Vice F L, Schwietzer-Kenney E L, Taciak V L, Bosma J F
Department of Pediatrics, University of Maryland School of Medicine, Baltimore 21201, USA.
Dev Med Child Neurol. 2001 Jan;43(1):22-7. doi: 10.1017/s0012162201000044.
Twenty healthy preterm infants (gestational age 26 to 33 weeks, postmenstrual age [PMA] 32.1 to 39.6 weeks, postnatal age [PNA] 2.0 to 11.6 weeks) were studied weekly from initiation of bottle feeding until discharge, with simultaneous digital recordings of pharyngeal and nipple (teat) pressure and nasal thermistor and thoracic strain gauge readings. The percentage of sucks aggregated into 'runs' (defined as > or = 3 sucks with < or = 2 seconds between suck peaks) increased over time and correlated significantly with PMA (r=0.601, p<0.001). The length of the sucking-runs also correlated significantly with PMA (r=0.613, p<0.001). The stability of sucking rhythm, defined as a function of the mean/SD of the suck interval, was also directly correlated with increasing PMA (r=0.503, p=0.002), as was increasing suck rate (r=0.379, p<0.03). None of these measures was correlated with PNA. Similarly, increasing PMA, but not PNA, correlated with a higher percentage of swallows in runs (r=0.364, p<0.03). Stability of swallow rhythm did not change significantly from 32 to 40 weeks' PMA. In low-risk preterm infants, increasing PMA is correlated with a faster and more stable sucking rhythm and with increasing organization into longer suck and swallow runs. Stable swallow rhythm appears to be established earlier than suck rhythm. The fact that PMA is a better predictor than PNA of these patterns lends support to the concept that these patterns are innate rather than learned behaviors. Quantitative assessment of the stability of suck and swallow rhythms in preterm infants may allow prediction of subsequent feeding dysfunction as well as more general underlying neurological impairment. Knowledge of the normal ontogeny of the rhythms of suck and swallow may also enable us to differentiate immature (but normal) feeding patterns in preterm infants from dysmature (abnormal) patterns, allowing more appropriate intervention measures.
选取了20名健康的早产儿（胎龄26至33周，月经龄[PMA]32.1至39.6周，出生后年龄[PNA]2.0至11.6周），从开始奶瓶喂养直至出院，每周进行研究，同时通过数字记录咽部和乳头（奶嘴）压力以及鼻热敏电阻和胸应变仪读数。聚集成“阵次”（定义为峰值之间间隔≤2秒的≥3次吸吮）的吸吮百分比随时间增加，且与PMA显著相关（r = 0.601，p < 0.001）。吸吮阵次的时长也与PMA显著相关（r = 0.613，p < 0.001）。吸吮节律的稳定性定义为吸吮间隔的均值/标准差的函数，也与PMA增加直接相关（r = 0.503，p = 0.002），吸吮频率增加也是如此（r = 0.379，p < 0.03）。这些指标均与PNA无关。同样，PMA增加而非PNA增加与阵次中吞咽百分比更高相关（r = 0.364，p < 0.03）。从PMA 32周到40周，吞咽节律的稳定性没有显著变化。在低风险早产儿中，PMA增加与更快、更稳定的吸吮节律以及更长的吸吮和吞咽阵次的组织化增加相关。稳定的吞咽节律似乎比吸吮节律更早建立。PMA比PNA更能预测这些模式，这一事实支持了这些模式是先天而非习得行为的概念。对早产儿吸吮和吞咽节律稳定性的定量评估可能有助于预测随后的喂养功能障碍以及更普遍的潜在神经损伤。了解吸吮和吞咽节律的正常个体发育情况也可能使我们能够区分早产儿不成熟（但正常）的喂养模式与发育异常（异常）的模式，从而采取更合适的干预措施。
