The Effect of Severe Intraventricular Hemorrhage on the Biorhythms of Feeding in Premature Infants

Abstract

Background: Suck-swallow rhythmicity and the integration of breathing into infant feeding are developmentally regulated. Neurological injury and breathing abnormalities can both impact feeding in preterm infants.Objective: To determine the effects of neurologic injury independent of effects of disordered breathing on feeding biorhythms in premature infants.Methods: Low-risk preterm infants (LRP), infants with Grade 3–4 Intraventricular Hemorrhage (IVH), those with bronchopulmonary dysplasia (BPD), and those with both BPD and IVH (BPD+IVH) were identified. Forty-seven infants, 32–42 weeks Postmenstrual Age (PMA) were evaluated on one or more occasions (131 studies). Of these, 39 infants (81 studies) were performed at >35 weeks PMA. Coefficient of variation (COV) (=standard deviation of the inter-event (e.g., suck-suck, swallow-breath, etc.) interval divided by the mean of the interval) was used to quantify rhythmic stability.Results: To adjust for PMA, only those infants >35–42 weeks were compared. Suck-suck COV was significantly lower (more rhythmically stable) in the LRP group [COV = 0.274 ± 0.051 (S.D.)] compared to all other groups (BPD = 0.325 ± 0.066; IVH = 0.342 ± 0.072; BPD + IVH = 0.314 ± 0.069; all p < 0.05). Similarly, suck-swallow COV was significantly lower in LRP babies (0.360 ± 0.066) compared to the BPD group (0.475 ± 0.113) and the IVH cohort (0.428 ± 0.075) (p < 0.05). The BPD+IVH group (0.424 ± 0.109), while higher, was not quite statistically significant.Conclusions: Severe IVH negatively impacts suck-suck and suck-swallow rhythms. The independent effect of neurological injury in the form of IVH on feeding rhythms suggests that quantitative analysis of feeding may reflect and predict neurological sequelae.

Predictability of neonatal sucking for later developmental outcomes

“…In all cases when a dysfunctional suck is diagnosed, there is a neurological issue that has been identified or soon will be identified. 9 These may include diagnoses such as, grade III intraventricular hemorrhage (IVH), 9 periventricular leukomalacia (PVL), perinatal hypoxic ischemic encephalopathy (HIE), seizure disorder, hydrocephalus, meconium aspiration, meconium staining, congenital anomalies, placenta abruptio with decreased muscle tone, chromosomal abnormalities, and neonatal encephalopathy of unknown etiology, to name a few. It has been reported that in addition to an association with dysfunctional sucking, severe IVH negatively impacts the suck-swallow-breathe rhythm.…”

“…The independent effect of neurological injury in the form of IVH on early neonatal feeding coordination suggests that a closer analysis of feeding may reflect and predict neurological sequelae. 9 Early diagnosis of the neonatal suck pattern is important because of the complexity of the neuronal network needed to suck and neuroplasticity in infancy. Because of this, the skill of sucking has the unique ability to give insight into areas of the brain that may be damaged either during or before birth.…”