Swallow–Breath Interaction and Phase of Respiration with Swallow during Non-Nutritive Suck in Infants Affected by Neonatal Abstinence Syndrome

Abstract

BackgroundThe development of suck–swallow–breath rhythms during non-nutritive suck (NNS) may be an indicator of neurologic integrity. We have described swallow–breath (SwBr) interaction and phase of respiration (POR) with swallow during NNS in low-risk preterm (LRP) infants. NNS in infants with neonatal abstinence syndrome (NAS) has not been described with our method.MethodSuckle, swallow, thoracic motion, and nasal airflow were measured during NNS in 10 infants with NAS and 12 unaffected infants (control). Logistic regression models were fit to describe the three types of SwBr and five types of POR in terms of the independent variables (gender, gestational age, birth weight, postmenstrual age, weeks postfirst nipple feed and swallows per study). We also compared the NAS group to 16 LRP infants.ResultsIn the NAS group, there were 94 swallows in 18 studies. In the control group, there were 94 swallows in 12 studies. There were statistical differences between groups for all three types of SwBr. The distribution of SwBr in NAS was similar to LRP infants with NAS having fewer swallows with attenuated respiration and more with central apnea. For POR, there were few differences. Over time, the distribution of SwBr in NAS infants approaches that of control infants.DiscussionVariability in SwBr and POR during NNS may represent neurologic dysfunction in infants with NAS. Specifically, term infants with NAS display an immature pattern of SwBr making them more similar to preterm infants, rather than a unique pathology. The distribution of SwBr and POR in NAS infants becomes more like term infants, possibly representing catch-up development as the NAS symptoms resolve.ConclusionSwBr in babies with NAS is different from that of unaffected term infants, actually being similar to preterm infants. Infants with NAS exhibit a dysmature pattern of NNS development which resolves over time.

Swallow-Breath Interaction and Phase of Respiration with Swallow During Nonnutritive Suck in Term Infants and Preterm Infants Approaching Term Adjusted Age

“…We have previously used our method to describe the coordination of suck, swallow and breath rhythms during nonnutritive suck in low-risk preterm infants 8 , preterm infants affected by bronchopulmonary dysplasia 10 , and in infants affected by neonatal abstinence syndrome 11 . In our work with low-risk preterm infants, we have shown that SwBr and POR develop in predictable and measurable ways.…”

“…• Other biometric data (ECG, SpO2), 2 types of acoustic data, and short-and long-term developmental outcomes were collected for use in other studies. This is the same method used for our study of preterm infants with bronchopulmonary dysplasia and term infants with neonatal abstinence syndrome [10][11] . Figure One is a diagram of the instrumentation used on each study infant.…”

“…The progression of POR in these infants was more affected by measures of maturation, indicating a developmental progression. We have also described SwBr and POR in preterm infants affected by bronchopulmonary dysplasia 10 and term infants with neonatal abstinence syndrome 11 . Our method has not yet been applied to healthy term infants.…”

Wireless skin sensors for physiological monitoring of infants in low-income and middle-income countries

“…[25][26][27] Capturing the respiratory rate and respiratory phase with swallowing in a single data stream might permit continuous tracking of a neonate's ability to suck, swallow, and breathe to guide feeding interventions. 28 The ability to assess surrogates of blood pressure continuously via the skin offers alternative placement of invasive arterial lines, which are often not feasible in LMICs. Furthermore, invasive arterial lines can cause serious neonatal complications, such as vascular thrombosis, occlusion, infection, rupture, bleeding, and even death.…”

Five-parameter evaluation of dysphagia: A novel prognostic scale for assessing neurological decline in Gaucher disease type 2

“…Dyssynchronization is defined as a disorder in the timing of the bolus flow through the pharynx. It was evaluated by clinical and videofluoroscopic evaluation and was scored as a binary 0/1, for absence/presence of dyssynchronization [16,17]. Head extension is commonly seen in patients with dysphagia as a compensatory measure that aids in the oral phase of swallowing, when the swallow itself is inadequate for passage of a bolus into the esophagus [4,18].…”