Centre for Pediatric & Adolescent Gastroenterology, Children, Youth & Women's Health Service, Women's and Children's Hospital, North Adelaide (SA), Australia.
Neurogastroenterol Motil. 2011 Oct;23(10):e401-8. doi: 10.1111/j.1365-2982.2011.01763.x. Epub 2011 Aug 9.
Poor feeding is a common cause of prolonged hospitalization of preterm infants. Pharyngeal and upper esophageal sphincter (UES) function of preterm infants has been technically difficult to assess and is therefore poorly characterized. The aim of this study was to assess the development of pharyngeal motility, UES function, and their coordination during nutritive swallowing in preterm infants.
Development of swallowing was assessed in 18 preterm infants. High resolution manometry was performed at first oral feeding attempt (31-32 week) and then weekly for 4 weeks. Pharyngeal and UES pressure changes were characterized in 980 swallows.
During swallowing, we observed an age-related increase in peak pharyngeal pressure at the laryngeal inlet (1 cm above UES) but an age-related decrease in the time required for the UES to fully relax to nadir. Analysis of the timing of proximal pharyngeal contractile peak and UES nadir showed that the UES was not fully relaxed when bolus propulsive forces were at their peak in the youngest infants.
CONCLUSIONS & INFERENCES: Results show developmental changes in infant swallow physiology that can be clearly linked to the effectiveness of nutritive swallowing. Most preterm infants demonstrated poor pharyngeal pressures at the laryngeal inlet coupled with poor coordination of pharyngeal propulsion with UES relaxation. These pressure patterns were less efficient than those demonstrated by older infants who were more adept at feeding. These observations may explain why infants under 34 weeks are physiologically unable to feed effectively and experience frequent choking and fatigue during feeding.
喂养不良是导致早产儿住院时间延长的常见原因。早产儿的咽和食管上括约肌（UES）功能在技术上难以评估，因此特征描述较差。本研究旨在评估早产儿在营养性吞咽过程中咽运动、UES 功能及其协调性的发育情况。
对 18 名早产儿进行吞咽发育评估。在首次经口喂养尝试（31-32 周）时和之后的 4 周内每周进行一次高分辨率测压。对 980 次吞咽进行了咽和 UES 压力变化的特征描述。
在吞咽过程中，我们观察到随着年龄的增长，UES 上方 1 厘米处的咽入口峰值压力增加，但UES 完全松弛至最低点所需的时间随着年龄的增长而减少。对近端咽收缩峰值和UES 最低点的时间分析表明，在最年轻的婴儿中，当推注力达到峰值时，UES 并未完全松弛。
结果显示婴儿吞咽生理的发育变化，可以与营养性吞咽的有效性明确相关。大多数早产儿的咽入口处的压力较低，同时UES 松弛与咽推进的协调性较差。这些压力模式的效率低于年龄较大的婴儿，后者在喂养方面更为熟练。这些观察结果可能解释了为什么 34 周以下的婴儿在生理上无法有效喂养，并且在喂养过程中经常出现窒息和疲劳。
