Bourgoin-Heck Mélisande, Specq Marie-Laure, Samson Nathalie, Nadeau Charlène, Prodel Martin, Corbin François, Praud Jean-Paul
Respiratory Physiology Department, CHU de Poitiers, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France.
Neonatology. 2015;108(1):42-8. doi: 10.1159/000381205. Epub 2015 May 9.
Hyperbilirubinemia (HB) occurs in 90% of preterm newborns. HB induces acute neurological disorders (somnolence, abnormal tone, feeding difficulties, auditory dysfunction) and alterations in respiratory control. These findings suggest brainstem neurotoxicity that could also affect swallowing centers.
To test the hypothesis that HB impairs nutritive swallowing (NS) and swallowing-breathing coordination.
Two groups of preterm lambs (born 14 days prior to term), namely control (n = 6) and HB (n = 5), were studied. On day 5 of life (D0), moderate HB (150-250 µmol/l) was induced during 17 h in the HB group. Swallowing was assessed via recording of pharyngeal pressure and respiration by respiratory inductance plethysmography and pulse oximetry. The effect of HB on NS was assessed during standardized bottle-feeding. A second recording was performed 48 h after recovery from HB (D3).
Swallows were less frequent (p = 0.003) and of smaller volume (p = 0.01) in HB lambs while swallowing frequency was decreased (p = 0.004). These differences disappeared after HB normalization. Swallowing-breathing coordination was impaired in HB lambs, with a decrease in percent time with NS burst-related apneas/hypopneas at D0 and D3. Simultaneously, HB lambs tended to experience more severe desaturations (<80%) during bottle-feeding. Finally, following bottle-feeding, the respiratory rate was significantly lower, along with an increased apnea duration in HB lambs.
Swallowing and swallowing-breathing coordination are altered by acute moderate HB in preterm lambs. Decreased efficiency at bottle-feeding is accompanied by continuation of breathing during swallow bursts, which may promote lung aspiration.
90%的早产儿会出现高胆红素血症（HB）。HB会引发急性神经功能障碍（嗜睡、肌张力异常、喂养困难、听觉功能障碍）以及呼吸控制改变。这些发现提示脑干神经毒性，这也可能影响吞咽中枢。
检验HB会损害营养性吞咽（NS）和吞咽-呼吸协调性这一假设。
研究了两组早产羔羊（足月前14天出生），即对照组（n = 6）和HB组（n = 5）。在出生后第5天（D0），HB组在17小时内诱导产生中度HB（150 - 250 µmol/l）。通过记录咽压力以及用呼吸感应体积描记法和脉搏血氧饱和度测定法记录呼吸来评估吞咽情况。在标准化奶瓶喂养期间评估HB对NS的影响。在从HB恢复后48小时（D3）进行第二次记录。
HB组羔羊的吞咽频率较低（p = 0.003）且吞咽量较小（p = 0.01），同时吞咽频率降低（p = 0.004）。HB恢复正常后，这些差异消失。HB组羔羊的吞咽-呼吸协调性受损，在D0和D3时与NS爆发相关的呼吸暂停/低通气时间百分比降低。同时，HB组羔羊在奶瓶喂养期间往往会经历更严重的血氧饱和度下降（<80%）。最后，奶瓶喂养后，HB组羔羊的呼吸频率显著降低，呼吸暂停持续时间增加。
早产羔羊急性中度HB会改变吞咽和吞咽-呼吸协调性。奶瓶喂养效率降低伴随着吞咽爆发期间呼吸的持续，这可能会促进肺内误吸。
