Jadcherla Sudarshan R, Helmick Roseanna, Alshaikh Enas S, Osborn Erika K, Shaker Reza
Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Division of Neonatology and Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Dysphagia. 2025 May 16. doi: 10.1007/s00455-025-10832-4.
Effect of interventions or diseases on the mechanisms of swallowing difficulties, and indications to change nipples, flows, or formula thickness in high-risk infants remains unclear. We evaluated and compared the effects of nipple flows and/or formula thickness on pharyngoesophageal timing and amplitude characteristics during oral milk challenge (OMC). A total of 48 OMC trials were undertaken in 12 infants [born at 36.4 ± 3.8 weeks gestation, studied at 48.0 ± 5.6 weeks postmenstrual age (PMA)] concurrent with high resolution pharyngoesophageal manometry (HRPM). We evaluated timing and amplitude of swallowing characteristics (pharyngeal and esophageal contractile strength, duration, activity, pharyngeal peak interval variability, bursts, and rhythm) and volume intakes. We compared within and between the entities: un-thickened formula vs. thickened formula and slower- vs. faster flow nipple. OMC durations averaged 71 ± 31 s and did not differ between interventions (p > 0.05). Pharyngeal swallow rhythms (timing) and contractile characteristics were dependent on the interaction between nipple flow rates and formula thickness (p < 0.05). Thickness decreased overall contractility and modified distal pharyngeal contractile activity (p < 0.05), which is critical to opening the upper esophageal sphincter. A structural equation model was developed that revealed the influence of PMA, respiratory status, volume extracted, nipple flow rate, and thickener presence on pharyngeal swallowing frequency with a comparative fit index of 0.83. Oropharyngeal stimulus-types trigger, integrate, and modify brainstem mediated oral and pharyngeal rhythms and modulate contractility and airway protection mechanisms. Effects of therapies, maturation and diagnoses are measurable using these novel approaches at crib-side.
干预措施或疾病对吞咽困难机制的影响，以及高危婴儿更换奶嘴、流速或配方奶浓度的指征仍不明确。我们评估并比较了奶嘴流速和/或配方奶浓度对口服奶液激发试验（OMC）期间咽食管时间和幅度特征的影响。对12例婴儿[孕36.4±3.8周出生，在月经龄48.0±5.6周（PMA）时进行研究]同时进行高分辨率咽食管测压（HRPM），共进行了48次OMC试验。我们评估了吞咽特征的时间和幅度（咽和食管收缩强度、持续时间、活动、咽峰间隔变异性、爆发和节律）以及奶量摄入。我们比较了不同组之间：未增稠配方奶与增稠配方奶，以及慢流速奶嘴与快流速奶嘴。OMC持续时间平均为71±31秒，不同干预措施之间无差异（p>0.05）。咽吞咽节律（时间）和收缩特征取决于奶嘴流速和配方奶浓度之间的相互作用（p<0.05）。浓度降低了总体收缩力并改变了远端咽收缩活动（p<0.05），这对打开食管上括约肌至关重要。建立了一个结构方程模型，揭示了月经龄、呼吸状态、吸出量、奶嘴流速和增稠剂的存在对咽吞咽频率的影响，比较拟合指数为0.83。口咽刺激类型触发、整合并改变脑干介导的口腔和咽节律，并调节收缩力和气道保护机制。使用这些新颖的床边方法可以测量治疗、成熟度和诊断的效果。
