Airway protective and abdominal expulsive mechanisms in infantile regurgitation

To define the expulsive and airway protective mechanisms involved in infantile regurgitation, we studied 15 infants (9 premature and 6 mature infants) with histories of frequent postfeeding regurgitation. In 13 infants we recorded pharyngeal pressure, pH, nasal and oral airflow, and abdominal respiratory movements. In two additional infants we recorded gastric pressure. In eight infants observations were made without intrapharyngeal recording devices. Distinctive abdominal regurgitation movements (RMs) immediately preceded 84% of regurgitation episodes. These RMs were characterized by one or more large brief increases in abdominal girth. In the two infants with gastric pressure recordings, large increases in gastric pressure, with duration and frequency characteristics similar to the RMs, immediately preceded regurgitation episodes. Thus, in contrast to the generally accepted concept that flow of gastric contents out of the stomach is passive during infantile regurgitation, we documented an active expulsive mechanism similar to that of vomiting in the adult. In all regurgitation episodes, upper airway closure occurred at the onset of the regurgitation movement. One or more swallows occurred immediately following RMs and prior to airway reopening in 97% of regurgitation episodes. Brief respiratory pauses occurred during regurgitation in all premature infants and occasionally in mature infants. Nasal regurgitation, coughing, and sneezing occasionally accompanied regurgitation episodes. Thus upper airway closure and swallowing prior to airway reopening were the most frequently observed airway protective mechanisms during regurgitation. Brief respiratory pauses, sneezing, and coughing may be secondary airway protective mechanisms. Nasal regurgitation likely represents immaturity of airway protective mechanisms.