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Maturational changes in the rhythms, patterning, and coordination of respiration and swallow during feeding in

Ira H Gewolb1, Frank L Vice

  • 1Division of Neonatology, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, MI 48912, USA. gewolb@msu.edu

Developmental Medicine and Child Neurology
|June 20, 2006
PubMed

Insights

The coordination of breathing and swallowing improves with infant postmenstrual age (PMA). This improved coordination, particularly reduced apneic swallows, begins after 36 weeks

Area of Science:

  • Neonatal Physiology
  • Developmental Neuroscience
  • Pediatric Respiration and Swallowing

Background:

  • Feeding coordination in infants involves complex integration of suck, swallow, and respiration.
  • Previous research indicates stabilization of suck and suck-swallow rhythms around 36 weeks postmenstrual age (PMA).
  • The developmental trajectory of respiration-swallow coordination requires further elucidation.

Purpose of the Study:

  • To investigate the coordination between respiration and swallowing rhythms in preterm and term infants.
  • To determine how this coordination evolves with increasing postmenstrual age (PMA).
  • To assess the predictive value of swallow-respiration coordination for infant development.

Main Methods:

  • Feeding episodes were assessed in preterm and term infants using pharyngeal pressure transducers for swallows and thoracoabdominal strain gauges for respiratory efforts.
  • Analysis included coefficients of variation (COVs) of breath-breath and swallow-breath intervals, percentage of apneic swallows, and respiratory phase relative to swallowing.
  • Infants were categorized by postmenstrual age (PMA), including preterm infants (< or =35 weeks PMA and >35 weeks PMA) and term infants (1-4 days and 1 month).

Main Results:

  • The percentage of apneic swallows significantly decreased with increasing PMA (p<0.001).
  • Term infants exhibited significantly lower breath-breath interval variability (BR-BR COV) compared to preterm infants.
  • Swallow-respiration phase relation stabilized with increasing PMA, showing decreased apnea and more swallows at end-inspiration.

Conclusions:

  • Improvement in respiration-swallow coordination emerges later than suck-swallow rhythm stabilization, beginning after approximately 36 weeks' PMA.
  • Enhanced coordination is characterized by fewer apneic swallows and a stable respiratory phase during swallowing.
  • The coordination of swallow-respiration and suck-swallow rhythms may serve as a predictor for feeding, respiratory, and neurodevelopmental outcomes.

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