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Gestational and postnatal modulation of esophageal sphincter reflexes in human premature neonates

Sudarshan R Jadcherla1,2,3, Theresa R Shubert1, Manish B Malkar1,2,3

  • 1The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.

Pediatric Research
|August 14, 2015
PubMed

Insights

Very-preterm infants show delayed upper and lower esophageal sphincter reflex maturation compared to preterm infants. Liquid stimuli further prolonged these reflexes in very-preterm neonates, indicating maturation progresses with gestational age.

Area of Science:

  • Neonatology
  • Gastroenterology
  • Developmental Physiology

Background:

  • Gestational age and postnatal maturation effects on esophageal sphincter reflex development are unclear.
  • Very-preterm (VPT) neonates (<32 weeks GA) may have delayed upper esophageal contractile reflex (UESCR) and lower esophageal relaxation reflex (LESRR) maturation compared to preterm (PT) neonates.

Purpose of the Study:

  • To investigate the impact of gestational age on the maturation of UESCR and LESRR in neonates.
  • To compare the sensory-motor characteristics of UESCR and LESRR between VPT and PT neonates.

Main Methods:

  • Provocative manometry used to assess UESCR and LESRR in 24 VPT and 12 PT neonates.
  • Investigated responses to 1,263 graded mid-esophageal stimuli (air, liquid).
  • Compared sensory-motor characteristics based on gestational age and stimulus type.

Main Results:

  • VPT neonates exhibited prolonged UESCR and LESRR response latencies and durations with liquid stimuli compared to PT neonates.
  • PT neonates showed prolonged LESRR response latency but similar UESCR/LESRR durations versus VPT neonates.
  • Increasing gestational age correlated with decreased UESCR/LESRR response latencies and increased LESRR duration, particularly with liquid stimuli.

Conclusions:

  • Vagus-mediated, mechano-sensitive, and liquid-sensitive reflex characteristics of UESCR and LESRR are distinct.
  • LESRR maturation varies with intrauterine development, suggesting inhibitory modulation progresses with advancing gestational age.
  • Findings highlight distinct reflex maturation patterns influenced by gestational age and stimulus type in neonates.
Abstract

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