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Alae nasi activation in preterm infants during oral feeding
B J Timms1, J M DiFiore, R J Martin
1Rainbow Babies' and Children's Hospital, Case Western Reserve University, Cleveland, Ohio 44106.
Insights
Preterm infants activate upper airway muscles during feeding, indicating a compensatory response to impaired ventilation. This muscle activation correlates with decreased oxygen saturation and minute ventilation.
Area of Science:
- Neonatal Physiology
- Respiratory Control
- Pediatric Medicine
Background:
- Preterm infants often experience impaired ventilation during oral feeding, leading to hypoxemia and hypercarbia.
- The ala nasi muscle plays a role in upper airway function and may be involved in respiratory adjustments.
Purpose of the Study:
- To investigate whether preterm infants activate the ala nasi muscle in response to ventilatory changes during oral feeding.
- To quantify the electromyographic activity of the ala nasi during different feeding and sucking conditions.
Main Methods:
- Ten preterm infants were studied using nasal airflow measurement, ala nasi electromyography (EMGAN), and monitoring of end-tidal CO2 and O2 saturation.
- EMGAN activity and nasal airflow were recorded during control, continuous feeding, intermittent feeding, and nonnutritive sucking periods.
Main Results:
- The percentage of breaths with EMGAN activity significantly increased from 41% during the control period to over 93% during continuous and intermittent feeding (p < 0.05).
- EMGAN activity amplitude also increased significantly during feeding compared to the control period (p < 0.05).
- Feeding was associated with a decrease in O2 saturation and minute ventilation (p < 0.05).
Conclusions:
- Preterm infants demonstrate increased ala nasi muscle activation during oral feeding, suggesting a compensatory mechanism for altered ventilation.
- This activation is linked to decreased oxygen saturation and minute ventilation, highlighting the challenges of oral feeding in this population.
Abstract:
Preterm infants may demonstrate impaired ventilation during oral feeding with resultant hypoxemia and hypercarbia. This study was designed to determine whether infants activate a representative upper airway muscle, the ala nasi, in response to these ventilatory changes. Ten preterm infants (postconceptional age at study 35 +/- 4 wk, weight 2.2 +/- 0.1 kg) were studied during a control period, continuous feeding, subsequent intermittent feeding, and a period of nonnutritive sucking. Nasal airflow was measured with a pneumotachometer to quantify minute ventilation. The alae nasi electromyogram (EMGAN) was recorded with surface electrodes, and sucking pressure was detected by a catheter in the feeding nipple. End-tidal CO2 and O2 saturation were also recorded during each period. The percentage of breaths associated with EMGAN activity increased from 41 +/- 13% during the control period to 95 +/- 5% and 93 +/- 7% during continuous and intermittent sucking, respectively (p < 0.05). Eighty-seven +/- 5% of EMGAN activity occurred during inspiration. During continuous and intermittent sucking, the amplitude of EMGAN activity also increased (6.8 +/- 5.2 and 6.7 +/- 4.0 arbitrary units/breath, respectively) compared with the control period (2.4 +/- 2.8 units/breath, p < 0.05). In association with the increase in EMGAN activity, O2 saturation fell from 98 +/- 1% in the control period to 95 +/- 1% during both continuous and intermittent feeding (p < 0.05), and minute ventilation fell from 274 +/- 80 mL/min/kg during the control period to 190 +/- 81 and 208 +/- 57 mL/min/kg during continuous and intermittent feeding, respectively (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)