Maturation Modulates Pharyngeal-Stimulus Provoked Pharyngeal and Respiratory Rhythms in Human Infants.
Kathryn A Hasenstab, Swetha Sitaram, Ivan M Lang and 2 others
PMID 28828751WHAT IT FOUND
Pharyngeal reflexes in preterm infants changed with age and water volume.
As they matured toward full oral feeds, swallowing sequences had fewer peaks and shorter breathing pauses. Larger volumes produced more responses and peaks, without changing breathing rhythms.
Key findings
01Of 185 pharyngeal swallow responses, 160 (86%) were multiple pharyngeal swallow sequences.
02With maturation, breathing pauses during swallowing and number of pharyngeal peaks decreased, and the swallowing rhythm became more stable.
03With larger stimulus volumes, responses and pharyngeal peaks became more common, but the peak rate, rhythm stability, and breathing rhythms did not change.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study followed infants who achieved full oral feeds, so it says little about infants who remain unsafe or unsuccessful feeders. The infants were heterogeneous, including inpatient and outpatient subjects, some on nasal cannula oxygen, and some convalescing from lung disease. The stimulus was sterile water infused into the pharynx, not natural oral feeding with breast milk or formula, bolus extraction, pacing, viscosity, taste, osmolality, or position. The study cannot separate brainstem, sensory and motor pathway, central pattern generator, and oromotor tongue or jaw contributions. The outcomes were pharyngeal and respiratory waveform characteristics, not a treatment effect or tested intervention.
Declared interests
The authors declared no conflicts of interest. The article is listed as supported by N.I.H. extramural research.
The easy way to misread this
Do not read multiple pharyngeal peaks or symptoms after water provocation as proof of dysphagia. These responses occurred in infants who achieved full oral feeds, and symptoms can coexist with protective reflexes.