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Pulmonary protective mechanisms in human infants
The American Review of Respiratory Disease
|May 1, 1985
Summary
Infants frequently swallow secretions during sleep, a key mechanism for airway protection and preventing aspiration pneumonia. This study explores the reflexes and coordination of these swallows, especially during apnea.
Area of Science:
- Pediatrics
- Pulmonology
- Gastroenterology
Background:
- Pulmonary aspiration of oral and nasal secretions during sleep is a recognized cause of bacterial pneumonia in infants and adults.
- Infants exhibit a higher frequency of swallowing during sleep compared to adults, facilitating the transport of secretions to the digestive tract.
- Nonfeeding swallows, characterized by brief airway closure, are observed during apneic spells in preterm infants, with underlying reflex mechanisms remaining unclear.
Purpose of the Study:
- To investigate the mechanisms of airway protection during sleep in infants, focusing on swallowing reflexes and their coordination with respiration.
- To explore the association between regurgitation and apnea in infants and the potential role of laryngeal chemoreceptors.
- To elucidate the unclear reflex mechanisms responsible for nonfeeding swallows during apnea in preterm infants.
Main Methods:
- Observational study analyzing swallowing patterns and respiratory coordination during sleep in infants.
- Documentation of "swallow-breaths" and their temporal relationship with the respiratory cycle.
- Investigation of airway closure events during nonfeeding swallows and postfeeding regurgitation.
Main Results:
- Swallowing during sleep is a primary mechanism for clearing oral and nasal secretions in infants, with a higher rate than in adults.
- Nonfeeding swallows, involving airway closure, are frequently observed during mixed and obstructive apneic spells in preterm infants.
- Postfeeding regurgitation and upper airway closure occur in close sequence, suggesting a protective airway mechanism, though the simultaneous occurrence with prolonged apnea in some infants is unexplained.
Conclusions:
- Swallowing during sleep plays a crucial role in airway protection and preventing aspiration in infants.
- The reflex mechanisms governing nonfeeding swallows during apnea require further investigation.
- The association between regurgitation and apnea in infants may involve laryngeal chemoreceptors, warranting further study.