Development Of Co‐Ordination Of Sucking, Swallowing And Breathing: Ultrasound Study Of Term And Preterm Infants

Abstract

SUMMARY Fourteen newborn babies of different gestational ages (33 to 40 weeks) but similar postnatal age (four to 19 days) were studied during bottle‐feeding using real‐time ultrasonography, combined with respiratory monitoring. Previously undescribed tongue movements and graded changes in the temporal relationships between tongue movements, swallowing and breathing were observed among infants of differing maturity. These were most marked in the least mature infants, but were occasionally seen in term infants. The results suggest that adequate neuromuscular co‐ordination is more a function of gestational maturity than of postnatal sucking experience. The pattern of intraoral events for infants of differing maturity described in this study provides a framework for the study of feeding problems of term and preterm infants. RÉSUMÉ Développement de la coordination, de la succion, de la déglutition et de la respiration chez les nourrissons nés à terme et chez les prématurés Quatorze nouveaux‐nés d'âges differents de gestation (33 à 40 semaines) mais d'âges post‐nataux semblables (quatre à 19 jours) on*** été étudiés durant l'alimentation au biberon en utilisant une échographie en temps reel combinée avec un contrôle respiratoire. Des mouvements de langue non décrits antérieurement et des modifications graduées dans les relations temporelles entre les mouvements de langue, la déglutition et la respiration ont été observés chez les nourrissons de differentes maturités. Ils étaient au plus élevé chez les moins matures des enfants étudiés mais observés occasionnellement chez les nourrissons à terme. Les résultats suggèrent que la coordination neuro‐musculaire adéquate est plus une fonction de la maturité de gestation que de l'expérience post‐natale de succion. La distribution des évènements intra‐oraux pour les nourrissons de differentes maturités décrites dans cette étude fournit une base de travail pour l'étude des problèmes d'alimentation chez les nourrissons à terme et prématurés. ZUSAMMENFASSUNG Koordinationsentwicklung von Saugen, Schlucken und Atmen bei reif‐ und frühgeborenen Kindern Bei 14 Neugeborenen mit verschiedenem Gestationsalter (33 bis 40 Wochen), aber etwa gleichem Lebensalter (vier bis 19 Tage) wurden während der Flaschenfütterung Real‐Zeit Ultraschalluntersuchungen mit gleichzeitigen Aufzeichnungen der Atmung durchgeführt. Es wurden bisher nicht beschriebene Zungenbewegungen und abgestufte Veränderungen in der zeitlichen Relation zwischen Zungenbewegungen, Schlucken und Atmen bei Kindern mit unterschiedlichem Reifegrad festgestellt. Diese waren bei den unreifsten Kindern am ausgeprägtesten, wurden aber auch bei einigen reifen Kindern beobachtet. Die Ergebnisse zeigen, daβ eine richtige neuromuskuläre Koordination eher eine Funktion der Gestationsreife als der postnatalen Saugerfahrung ist. Die Muster intra‐oraler Abläufe bei Kindern unterschiedlicher Reife, die in dieser Studie beschrieben werden, bilden die Basis für Untersuchungen von Fütterungsproblemen bei reif‐ und frühgeborenen Kindern. RESUMEN D...

Attainment of early feeding milestones in preterm neonates

“…These findings are consistent with the findings of previous studies of preterm neonates, which have reported that suckling skills [6][7][8] and the coordination of suckling, swallowing and breathing [9][10][11][12][13][14][15] improve with ongoing maturity. These findings are also consistent with previous studies that have suggested that certain morbidities affecting body-systems involved in feeding, such as the respiratory and circulatory systems, may affect the efficiency of suckle-feeding in preterm neonates.…”

“…5 Depending on their GA at birth, preterm neonates may display various degrees of immaturity of their nervous, anatomical and physiological control systems, which have the potential to affect the strength, coordination and efficiency of the skills required for suckle-feeding. Several studies have documented that for preterm neonates, suckling skills [6][7][8] and the coordination of suckling, swallowing and breathing [9][10][11][12][13][14][15] improve with ongoing post-natal maturation. However, few studies have specifically investigated the relationship between GA at birth and either GA at commencement of suckle-feeds or GA at attainment of exclusive suckle-feeding.…”

Sucking and swallowing in infants and diagnostic tools

“…The coordination of swallow-respiration and suck-swallow rhythms may be predictive of feeding, respiratory and neurodevelopmental abnormalities. 23 Infants with BPD, however, do not follow predicted maturational patterns of sucking-swallowing rhythmic integration. A follow-up study of Gewolb and Vice 32 suggests that ventilatory needs may modulate sucking rhythm and organization.…”

“…Feeding activity appears to override normal ventilatory chemoreceptor control mechanisms 23 and the act of swallowing has a significant impact on breathing during feeding. As infants commonly swallow as often as 60 times a minute, and there is an airway closure averaging 530 ms associated with swallows, this means that during the initial period of continuous sucking, the airway closure lasts up to 30 s a minute.…”

The development of potentially better practices to support the neurodevelopment of infants in the NICU

“…The infant may demonstrate rudimentary components of sucking and swallowing by 28 weeks gestation. 155 At about 32 weeks gestation, an infant will begin to display bursts of sucking, and by 34 weeks a rhythmic suck, swallow and breathe pattern is developing. [156][157][158][159][160][161] Non-nutritive sucking will transition towards more effective nutritive sucking, concurrent with state of alertness and increasing gestational age.…”