Gross Roxann Diez, Trapani-Hanasewych Marybeth
Department of Speech Therapy, The Children's Institute of Pittsburgh, Pittsburgh, Pennsylvania.
Semin Speech Lang. 2017 Apr;38(2):87-95. doi: 10.1055/s-0037-1599106. Epub 2017 Mar 21.
The anatomical overlap of the pathways for air passage and nutrition necessitate precise coordination between the two vital functions. Neuroanatomic structures in the brainstem for sucking, breathing, and swallowing are also in close proximity and must swiftly coordinate the processes. In a healthy neonate, the oropharyngeal experience and stimulation of early feeding enables respiratory control during suckling to develop. Despite wide variability among the methods used to investigate breathing and swallowing coordination in infancy, a consistent finding of postswallow exhalation has been reported. Postswallow exhalation is significant because the positive airflow of exhalation is believed to provide airway clearance. Preterm neonates and infants swallow during all phases of the respiratory cycle, but ultimately progress to the most commonly reported pattern, which is inhale-swallow-exhale. This pattern is similar to the adult pattern of exhale-swallow-exhale. Monitoring respiratory signals during nonnutritive sucking and early feeding may help to identify newborns with increased risk of aspiration and assist with clinical decision making.
气道和营养通路的解剖学重叠使得这两项重要功能之间需要精确协调。脑干中负责吸吮、呼吸和吞咽的神经解剖结构也彼此相邻，必须迅速协调这些过程。在健康的新生儿中，早期喂养时的口咽体验和刺激能够促使哺乳期间的呼吸控制得以发展。尽管用于研究婴儿期呼吸与吞咽协调的方法差异很大，但有报告称吞咽后呼气是一个一致的发现。吞咽后呼气很重要，因为呼气时的正向气流被认为可以提供气道清理。早产新生儿和婴儿在呼吸周期的所有阶段都会吞咽，但最终会发展为最常见的模式，即吸气-吞咽-呼气。这种模式类似于成人的呼气-吞咽-呼气模式。在非营养性吸吮和早期喂养期间监测呼吸信号，可能有助于识别有吸入风险增加的新生儿，并协助进行临床决策。
