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The relationship between rhythmic swallowing and breathing during suckle feeding in term neonates
O Bamford1, V Taciak, I H Gewolb
1Department of Pediatrics, University of Maryland, Baltimore 21201.
Insights
Newborn infants show poor coordination between suckle feeding and breathing. Rhythmic swallowing occurs at the expense of regular breathing patterns in the first 48 hours of life.
Area of Science:
- Neonatal physiology
- Developmental neuroscience
Background:
- Coordination between suckle feeding and breathing is crucial for infant survival.
- Limited data exists on the development of this coordination in early human infancy.
Purpose of the Study:
- To establish baseline data on breathing and swallowing coordination in newborns.
- To investigate the relationship between suckle feeding and respiratory patterns in the first 48 hours of life.
Main Methods:
- Recorded breathing and swallowing activity during bottle feeds in 23 infants (14-48 hours postnatal age).
- Analyzed swallow organization, intervals, and their relation to respiratory phases (inspiration/expiration).
- Quantified breathing rate, tidal volume, and oxygen saturation during feeding.
Main Results:
- Most swallows occurred in runs (68%), with intervals becoming slower over time.
- Swallowing intervals were more regular than breathing patterns.
- Suckle feeding significantly reduced breathing rate and tidal volume, leading to irregular respiratory airflow and common mild desaturation.
- Swallows occurred in all breathing phases, with a frequent pattern of inspiration-swallow-expiration (24%).
Conclusions:
- Human infants under 48 hours postnatal age exhibit poorly coordinated breathing and swallowing rhythms.
- Infants prioritize rhythmic swallowing, often compromising eupnea (normal breathing).
- Coordination improves with age, but initial feeding can disrupt respiratory stability.
Abstract:
Little is known of the development of efficient coordination between suckle feeding and breathing in human infants. To establish baseline data, we recorded breathing and swallowing activity during bottle feeds in 23 infants at 14-48 h postnatal age. Most swallows (overall mean 68%) were organized into runs, with intervals starting at 0.6-0.8 s and slowing to 1-1.3 s after 30-40 s. The proportion of run swallows to total swallows increased significantly with age. Swallow intervals were regular (coefficient of variation = 18-38%) compared with breathing (coefficient of variation = 50%). Both breathing rate and tidal volume were significantly reduced by the onset of suckle feeding, and the pattern of respiratory airflow became markedly irregular. Mild transient desaturation was common, but was not accompanied by changes in heart rate. Swallows could occur in all phases of breathing. Overall, equal numbers of swallows were preceded by expiration and inspiration, but twice as many were followed by expiration compared with inspiration. Swallows were classified by the respiratory phases both preceding and following the swallow. Swallows occurred in all possible classifications in each of the infants studied. The incidence of the most frequent classification (inspiration-swallow-expiration), was 24% overall (individual range 5-50%). The phase relation between swallows and breaths changed frequently but showed occasional short periods of stability during which the breathing became regular and tidal volume increased. We conclude that at less than 48 h the normal infant has little coordination between swallowing and breathing rhythms and maintains rhythmic swallowing at the expense of eupnea.