Sakalidis Vanessa S, Geddes Donna T
Medela Australia, Heatherton, Melbourne, Australia School of Chemistry and Biochemistry, The University of Western Australia, Crawley, Australia
School of Chemistry and Biochemistry, The University of Western Australia, Crawley, Australia.
J Hum Lact. 2016 May;32(2):201-11; quiz 393-5. doi: 10.1177/0890334415601093. Epub 2015 Aug 28.
Despite the importance of the suck-swallow-breathe reflex during breastfeeding, a large proportion of our understanding is derived from bottle-feeding studies. Given the differences in the delivery of milk during breast and bottle feeding, it is imperative that a more general view of the suck-swallow-breathe and milk removal process during breastfeeding is available. This systematic review aimed to assess the evidence for the mechanism of milk removal during breastfeeding; evaluate how the term infant coordinates sucking, swallowing, breathing (SSwB) and cardiorespiratory patterns; and how these patterns change with maturation during breastfeeding. A literature search of PubMed and MEDLINE was performed to assess the mechanism of milk removal and patterns of sucking, swallowing, breathing, and cardiorespiratory control during breastfeeding in healthy term infants. Seventeen studies were selected and a narrative synthesis was performed. Nine studies assessing the infant sucking mechanism consistently provided evidence that vacuum is essential to milk removal from the breast. The limited data on swallowing and breathing and cardiorespiratory control showed mixed results. Overall, results highlighted the high variability in breastfeeding studies and suggested that swallowing, breathing, and cardiorespiratory patterns change with maturation, and within a breastfeed. These findings show potential for devising breastfeeding interventions for populations at risk of SSwB problems. However, consistent methods and definitions of breastfeeding parameters are required before interventions can be adequately developed and tested.
尽管吸吮-吞咽-呼吸反射在母乳喂养过程中很重要，但我们的大部分认知都来自奶瓶喂养研究。鉴于母乳喂养和奶瓶喂养时乳汁输送方式的差异，有必要对母乳喂养期间的吸吮-吞咽-呼吸及乳汁移出过程有更全面的认识。本系统评价旨在评估母乳喂养期间乳汁移出机制的证据；评估足月儿如何协调吸吮、吞咽、呼吸（SSwB）及心肺模式；以及这些模式在母乳喂养过程中如何随成熟度变化。通过检索PubMed和MEDLINE数据库，评估健康足月儿母乳喂养期间的乳汁移出机制以及吸吮、吞咽、呼吸和心肺控制模式。共筛选出17项研究并进行了叙述性综合分析。9项评估婴儿吸吮机制的研究一致表明，负压对于从乳房移出乳汁至关重要。关于吞咽、呼吸和心肺控制的有限数据显示结果不一。总体而言，结果突出了母乳喂养研究中的高度变异性，并表明吞咽、呼吸和心肺模式会随成熟度以及在一次母乳喂养过程中发生变化。这些发现表明有可能为存在SSwB问题风险的人群设计母乳喂养干预措施。然而，在能够充分制定和测试干预措施之前，需要统一母乳喂养参数的方法和定义。
