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Upper gastrointestinal motility: prenatal development and problems in infancy
Maartje M J Singendonk1, Nathalie Rommel2, Taher I Omari3
1Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
Insights
This review covers prenatal development of upper gastrointestinal motility and common infant motility disorders. It discusses swallowing, breathing coordination, and feeding issues like gastro-oesophageal reflux (GER) in neonates.
Area of Science:
- Neonatal development
- Gastrointestinal motility
- Pediatric feeding disorders
Background:
- Swallowing (deglutition) is a complex process involving coordinated breathing and feeding.
- Infants born at 34 weeks gestational age can feed orally, but respiratory maturation is ongoing.
- Congenital and developmental disorders can affect swallowing and gastrointestinal motility, leading to feeding difficulties and aspiration.
Purpose of the Study:
- To review the prenatal development of upper gastrointestinal motility.
- To describe common gastrointestinal motility disorders in early infancy.
- To highlight the relationship between swallowing, breathing, and feeding in neonates.
Main Methods:
- Literature review of prenatal development of upper gastrointestinal motility.
- Analysis of common infant gastrointestinal motility disorders.
- Discussion of clinical manifestations including GER, feeding refusal, and aspiration.
Main Results:
- Swallowing and breathing coordination is crucial for successful feeding in neonates.
- Gastrointestinal motility disorders can manifest as GER, feeding difficulties, and aspiration.
- Oesophageal motility disorders are common after surgery for oesophageal atresia, with potential congenital origins.
Conclusions:
- Understanding prenatal gastrointestinal development is key to identifying infant motility disorders.
- Early identification and management of these disorders are essential for proper nutrition and development.
- Further research into congenital motility origins may improve treatment strategies.
Abstract:
Deglutition, or swallowing, refers to the process of propulsion of a food bolus from the mouth into the stomach and involves the highly coordinated interplay of swallowing and breathing. At 34 weeks gestational age most neonates are capable of successful oral feeding if born at this time; however, the maturation of respiration is still in progress at this stage. Infants can experience congenital and developmental pharyngeal and/or gastrointestinal motility disorders, which might manifest clinically as gastro-oesophageal reflux (GER) symptoms, feeding difficulties and/or refusal, choking episodes and airway changes secondary to micro or overt aspiration. These problems might lead to impaired nutritional intake and failure to thrive. These gastrointestinal motility disorders are mostly classified according to the phase of swallowing in which they occur, that is, the oral preparatory, oral, pharyngeal and oesophageal phases. GER is a common phenomenon in infancy and is referred to as GERD when it causes troublesome complications. GER is predominantly caused by transient relaxation of the lower oesophageal sphincter. In oesophageal atresia, oesophageal motility disorders develop in almost all patients after surgery; however, a congenital origin of disordered motility has also been proposed. This Review highlights the prenatal development of upper gastrointestinal motility and describes the most common motility disorders that occur in early infancy.
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