IN BRIEF

Swallowing Functions Remain Worse in Preterm Infants Even at Full-Term Equivalent Age

July 16, 2019
Written by

Preterm infants exerted greater effort than full-term infants to consume less than half the volume in a recent study led by researchers at Nationwide Children’s Hospital.

Preterm infants face many challenges as they enter the world too soon. One of the biggest challenges is learning the coordination of the suck-swallow refex that allows them to eat. During normal pregnancy, swallowing functions develop through swallowing experiences of amniotic fluid in utero until full-term birth. In preterm infants, it is expected that such skills are delayed and evolve with post-natal maturation.

While the evidence is clear that preterm infants have greater risk for dysphagia, it is not clear how postnatal maturation affects the muscular rhythms during oral feeding. In fact, according to a recent publication in Neurogastroenterology & Motility from Dr. Jadcherla and colleagues, pharyngeal contractile regulation is underdeveloped in perterm-born infants even after postnatal maturation equivalent to full-term status.

At worst, dysphagia results in the long-term use of a gastrostomy in an infant.

“Dysphagia manifests as eating-swallowing-aerodigestive difficulties in infants and it’s a growing contribution to the increasing health care burden,” says Sudarshan Jadcherla, MD, principal investigator in the Center for Perinatal Research in the Abigail Wexner Research Institute at Nationwide Children’s Hospital. He is also an attending neonatologist and medical director of the Neonatal and Infant Feeding Disorders Program. “Additionally, poor coordination of sucking, swallowing and breathing leads to feeding difficulties, associated prolonged hospitalizations and increased caregiver anxiety.”

Both preterm (<38 weeks gestation) and full-term infants admitted to Nationwide Children’s referred for swallowing evaluation were included in the study. The infants were either partially or fully orally feeding during the time of the study. High resolution manometry data measured pharyngeal contractile characteristics and regulatory characteristics. Overall, more than 2,000 pharyngeal contractions were analyzed from the 41 patients included in the study.

Preterm infants had lower milk extraction rates and swallowing efficiency as evidenced by decreased frequency and increased magnitude of pharyngeal contractility. Additionally, pharyngeal contractile regulation remained underdeveloped in preterm-born infants despite postnatal maturation equivalent to full-term status.

The results suggest that several factors in the neonatal intensive care unit may be inhibiting the maturation of safe and effective swallowing contractile and regulatory skills, says Dr. Jadcherla. He suggests that well-designed prospective studies would be best suited to further examine these variations and identify opportunities to improve outcomes.

“Only when we understand the causal and ameliorating mechanisms of eating, swallowing and aerodigestive dysfunctions will we be able to modify strategies for appropriate diagnostic, therapeutic and rehabilitative approaches to ensure safe feeding during and beyond NICU stay. If not, we run the risk of over- or under-utilizing gastronomy procedures,” says Dr. Jadcherla.

 

Citation:

Prabhakar V, Hasenstab KA, Osborn E, Wei L, Jadcherla SR. Pharyngeal contractile and regulatory characteristics are distinct during nutritive oral stimulus in preterm-born infants: Implications for clinical and research applications. Neurogastroenterology & Motility. 2019;00:d13650.

Photo credit: Nationwide Children’s