Breathing pattern and ventilation during oral feeding in term newborn infants

Clark, Mark L.; Pronske, Maria L.; Luna-Solarzano, Hortencia G.; Peterson, Mary Dale

doi:10.1016/s0022-3476(85)80363-2

Cited by 82 publications

(32 citation statements)

References 8 publications

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“…In this study, we explored possible compensatory mechanisms by which VE may be maximized during feeding. This study has confirmed previous findings with regard to the breathing and sucking pattern of preterm infants during feeding (1, 13,16). When compared with the control period, VE was significantly reduced during both continuous sucking and intermittent sucking in association with a significant reduction in 0 2 saturation.…”

Section: Discussionsupporting

confidence: 91%

Alae Nasi Activation in Preterm Infants during Oral Feeding

et al. 1992

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ABSTRACT. Preterm infants may demonstrate impaired ventilation during oral feeding with resultant hypoxemia and hypercarbia. This study was designed to determine whether infants activate a representative upper airway muscle, the ala nasi, in response to these ventilatory changes. Ten preterm infants (postconceptional age at study 35 f 4 wk, weight 2.2 f 0.1 kg) were studied during a control period, continuous feeding, subsequent intermittent feeding, and a period of nonnutritive sucking. Nasal airflow was measured with a pneumotachometer to quantify minute ventilation. The alae nasi electromyogram (EMGAN) was recorded with surface electrodes, and sucking pressure was detected by a catheter in the feeding nipple. End-tidal COz and OZ saturation were also recorded during each period. The percentage of breaths associated with EMGAN activity increased from 41 f 13% during the control period to 95 f 5% and 93 f 7% during continuous and intermittent sucking, respectively ( p < 0.05). Eightyseven +. 5% of EMGAN activity occurred during inspiration.During continuous and intermittent sucking, the amplitude of EMGAN activity also increased (6.8 f 5.2 and 6.7 f 4.0 arbitrary unitslbreath, respectively) compared with the control period (2.4 f 2.8 unitslbreath, p < 0.05). In association with the increase in EMGAN activity, Oz saturation fell from 98 f 1% in the control period to 95 +. 1% during both continuous and intermittent feeding (p < 0.05), and minute ventilation fell from 274 2 80 mL/min/kg during the control period to 190 f 81 and 208 f 57 mL/min/kg during continuous and intermittent feeding, respectively ( p < 0.05). We conclude that the preterm infant is able to activate the alae nasi while feeding. We speculate that activation of the upper airway muscles may contribute to reduction in upper airway resistance during feeding. (Pediatr Res 32: 679-682,1992) Abbreviations EMGAN, Alae nasi electromyogram PETC02, End-tidal carbon dioxide VR Minute ventilation NNS, Nonnutritive suckingThe preterm infant of less than 33-34 wk of gestation gradually develops adequate facility in oral feeding during the first weeks of life. The process of feeding challenges the infant to meet the simultaneous needs of both sustained ventilation and nutritive intake. The ability of the infant to modify the strategies of

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Section: Discussionsupporting

confidence: 91%

Alae Nasi Activation in Preterm Infants during Oral Feeding

et al. 1992

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“…Breast-and bottle-feeding may have different effects: Mathew and Bhatia (3) reported that breathing was reduced in bottle-fed but not in breast-fed infants and suggested that the difference is caused by the bottle producing faster flow, making the infant spend more time swallowing. Inspiratory time was unchanged in breast-feeding but fell during bottle-feeding (12,14). This could reduce minute ventilation because less time is available for air intake.…”

Section: Discussionmentioning

confidence: 99%

The Relationship between Rhythmic Swallowing and Breathing during Suckle Feeding in Term Neonates

1992

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ABSTRACT. Little is known of the development of efficient coordination between suckle feeding and breathing in human infants. To establish baseline data, we recorded breathing and swallowing activity during bottle feeds in 23 infants at 14-48 h postnatal age. Most swallows (overall mean 68%) were organized into runs, with intervals starting at 0.6-0.8 s and slowing to 1-1.3 s after 30-40 s. The proportion of run swallows to total swallows increased significantly with age. Swallow intervals were regular (coefficient of variation = 18-38%) compared with breathing (coefficient of variation = 50%). Both breathing rate and tidal volume were significantly reduced by the onset of suckle feeding, and the pattern of respiratory airflow became markedly irregular. Mild transient desaturation was common, but was not accompanied by changes in heart rate. Swallows could occur in all phases of breathing. Overall, equal numbers of swallows were preceded by expiration and inspiration, but twice as many were followed by expiration compared with inspiration. Swallows were classified by the respiratory phases both preceding and following the swallow. Swallows occurred in all possible classifications in each of the infants studied. The incidence of the most frequent classification (inspiration-swallowexpiration), was 24% overall (individual range 5-50%). The phase relation between swallows and breaths changed frequently but showed occasional short periods of stability during which the breathing became regular and tidal volume increased. We conclude that at <48 h the normal infant has little coordination between swallowing and breathing rhythms and maintains rhythmic swallowing at the expense of eupnea. (Pediatr Res 31: 619-624,1992)

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“…34 Minute ventilation is also lower (i.e., less air is moved per minute) due to lower respiratory frequency. 41,63 Oxygenation is more likely to drop during the first minute than during any other time throughout feeding. 11 The caregiver observes for a drop in oxygen saturation and for stress cues during the first 30 seconds after each nipple placement.…”

Section: Ability To Maintain Physiologic Stabilitymentioning

confidence: 99%

The Early Feeding Skills Assessment for Preterm Infants

Thoyre

Shaker²,

Pridham³

2005

Neonatal Network

212

143

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Preterm infants develop the skills necessary to begin oral feeding as their health stabilizes and as they reach a postconceptional age that supports coordination of breathing and swallowing with oralmotor functioning. The time from initiation of oral feeding to full oral feedings (with adequate intake for growth and maintenance of physiologic stability) can vary from days to months for the preterm infant. The approach to feeding the infant during this transition period must be developmentally supportive and tailored to meet the needs of the individual. To accomplish this, caregivers-notably nurses and parents-need to communicate about the specific skills that the infant has gained, about skills that are emerging, and about skills that the infant has not yet developed. The Early Feeding Skills (EFS) Assessment is a checklist for assessing infant readiness for and tolerance of feeding and for profiling the infant's developmental stage regarding specific feeding skills: the abilities to remain engaged in feeding, organize oral-motor functioning, coordinate swallowing with breathing, and maintain physiologic stability. This article introduces the EFS.Neonatal clinicians, clinicians who work with families during the early postdischarge period, and parents of preterm infants are in an important position to observe and support the development of an emergent motor skill: oral feeding. Oral feeding skills have commonly been conceptualized by health care providers as an infant's ability to organize and coordinate oralmotor functions to efficiently consume enough calories for growth. Early feeding skills are much more complex than this, however. They also involve the infant's ability to (1) engage and remain engaged in a physiologically and behaviorally challenging task, (2) organize oralmotor movements so as to have long-term functional benefits, (3) coordinate breathing with swallowing to avoid prolonged apnea or aspiration of fluids, and (4) regulate the depth and frequency of breathing to maintain physiologic stability.Motor skill development corresponds to changes in an infant's brain, body, and experience. 1 According to research, two factors affect progression in ability to feed orally: the infant's state of health 2-6 and oral feeding experience. [7][8][9][10][11] According to other research, neuromaturation of the following contributes to an individual infant's skill in feeding: the ability to regulate oxygen, 11,12 development of alertness, 13-15 and development of sucking strength and organization of the sucking pattern. 16,17 External influences can also change the nature of the task. These include the size and speed of flow of the fluid bolus, 18-20 the impact of nasogastric tubes in place during feeding, 21 and the type of feeding support provided by the caregiver. [22][23][24][25][26] During its emergent phase, motor skill expression varies considerably. 27 Early feeding skills can vary from feeding to feeding and even across a given feeding. Some infants adapt and improve in skill as the feeding pro...

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Breathing pattern and ventilation during oral feeding in term newborn infants

Cited by 82 publications

References 8 publications

Alae Nasi Activation in Preterm Infants during Oral Feeding

Alae Nasi Activation in Preterm Infants during Oral Feeding

The Relationship between Rhythmic Swallowing and Breathing during Suckle Feeding in Term Neonates

The Early Feeding Skills Assessment for Preterm Infants

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