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Upper and lower esophageal sphincter kinetics are modified during maturation: effect of pharyngeal stimulus in

Sudarshan R Jadcherla1, Theresa R Shubert2, Ish K Gulati1

  • 11] Department of Pediatrics, Sections of Neonatology, Pediatric Gastroenterology and Nutrition, The Ohio State University College of Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio [2] The Neonatal and Infant Feeding Disorders Program, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.

Pediatric Research
|October 4, 2014
PubMed

Insights

Swallowing reflexes in premature infants mature over time. Liquid stimuli are more effective than air for triggering these protective reflexes, indicating developmental changes in neural pathways.

Area of Science:

  • Neonatal Physiology
  • Gastrointestinal Motility
  • Neurodevelopment

Background:

  • Pharyngeal provocation elicits reflexes involving proximal and distal esophageal sphincters.
  • These reflexes are hypothesized to undergo longitudinal maturation during development.

Purpose of the Study:

  • To characterize pharyngeal stimulation-induced reflexes in premature neonates.
  • To investigate the maturation of esophageal sphincter kinetics and swallowing reflexes.

Main Methods:

  • Utilized novel pharyngo-esophageal motility methods in 19 healthy premature neonates.
  • Assessed reflexes at two time points: 34.7 wk and 39.3 wk postmenstrual age.
  • Administered graded volumes of air and sterile water to evoke pharyngeal reflexive swallow (PRS) and pharyngo-lower esophageal sphincter relaxation reflex (PLESRR).

Main Results:

  • Threshold volumes for PRS and PLESRR were similar for air and water.
  • Water stimulus elicited significantly more PRS responses than air.
  • Significant dose-response relationships were observed with water, but not air, for both PRS and PLESRR.

Conclusions:

  • The recruitment frequency of PRS and PLESRR increases with postnatal maturation.
  • Liquid is a superior medium for evoking these swallowing reflexes compared to air.
  • These findings suggest developmental modulation of excitatory and inhibitory pathways in aerodigestive protective reflexes.
Abstract

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