Breathing and Swallowing: The Next Frontier

The anatomical overlap of the pathways for air passage and nutrition necessitate precise coordination between the two vital functions. Neuroanatomic structures in the brainstem for sucking, breathing, and swallowing are also in close proximity and must swiftly coordinate the processes. In a healthy neonate, the oropharyngeal experience and stimulation of early feeding enables respiratory control during suckling to develop. Despite wide variability among the methods used to investigate breathing and swallowing coordination in infancy, a consistent finding of postswallow exhalation has been reported. Postswallow exhalation is significant because the positive airflow of exhalation is believed to provide airway clearance. Preterm neonates and infants swallow during all phases of the respiratory cycle, but ultimately progress to the most commonly reported pattern, which is inhale-swallow-exhale. This pattern is similar to the adult pattern of exhale-swallow-exhale. Monitoring respiratory signals during nonnutritive sucking and early feeding may help to identify newborns with increased risk of aspiration and assist with clinical decision making.