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Coordination of breathing and swallowing in human infants
Insights
Preterm infants exhibit spontaneous swallows during sleep and wakefulness, briefly closing airways. These swallows can prolong or obstruct respiratory cycles depending on lung volume at the time of the swallow-breath.
Area of Science:
- Physiology
- Neonatal Medicine
- Respiratory Physiology
Background:
- Spontaneous nonfeeding swallows are crucial for airway protection and development in preterm infants.
- Understanding the interplay between swallowing and respiration is vital for assessing infant health.
Purpose of the Study:
- To characterize spontaneous nonfeeding swallows in preterm infants during wakefulness and sleep.
- To investigate the relationship between swallowing and respiratory patterns, including airway closure and respiratory cycle duration.
Main Methods:
- Simultaneous recording of pharyngeal pressure, submental electromyogram, and respiratory airflow in nine preterm infants.
- Identification of 217 swallows during ongoing respiration, analyzing airway closure duration and respiratory cycle modifications.
Main Results:
- Spontaneous swallows in preterm infants involve brief airway closure (approx. 1s), independent of respiratory rate.
- A "swallow-breath" pattern was observed, confirming the respiratory nature of the swallow.
- Swallows interrupting respiration at higher lung volumes prolonged the respiratory cycle.
- Swallows at lower lung volumes led to obstructed inspiratory efforts.
Conclusions:
- Spontaneous swallowing in preterm infants is integrated with respiration, involving brief airway closure.
- The timing of swallows relative to lung volume influences respiratory cycle duration and potential obstruction.
- These findings provide insights into the complex cardiorespiratory control during infant development.
Abstract:
Spontaneous nonfeeding swallows taken during wakefulness and sleep were identified in nine preterm infants by characteristic patterns in pharyngeal pressure, submental electromyogram, and respiratory airflow. Two hundred and seventeen swallows during ongoing respiration interrupted either inspiratory or expiratory airflow with airway closure for approximately 1 s. The duration of airway closure was independent of respiratory rate. A brief "swallow-breath" was associated with swallow onset in most instances. The respiratory nature of this movement was confirmed by simultaneous recording of a fall in pharyngeal or esophageal pressure and outward movement of the abdomen. Prolongation of the respiratory cycle was generally observed when a swallow interrupted ventilation at higher lung volumes, i.e., in late inspiration or early expiration. When the swallow interrupted ventilation at lower lung volume, i.e, in late expiration or early inspiration, the subsequent inspiratory effort was usually obstructed as it preceded airway opening at the end of the swallow synergism.