The physiologic coupling of sucking and swallowing coordination provides a unique process for neonatal survival

Abstract

Aim Although the coordination of sucking and swallowing is critical for successful oral intake in neonates, the mechanisms that facilitate this coordination are not well understood. This investigation sought to clarify the mechanisms that facilitate this coordination, by comparing sucks that were coordinated with swallows and sucks that were completed in isolation. Methods Ten neonates with a median gestational age of 28.2 weeks, ranging from 27.0-35.0 weeks, were recruited from the neonatal nurseries at Nationwide Children's Hospital, Columbus, Ohio, USA. They were evaluated while bottle-feeding at term gestation for differences in characteristics between sucks that were coupled and not coupled with swallows. Suction was evaluated using an intraoral pressure transducer and swallows were identified using a micro-manometry pharyngeal catheter. Linear mixed models were applied to distinguish sucking characteristics. Results Suction exhibited an anti-phase relationship with the generation and release of positive pharyngeal pressure during the swallow. Coupled sucks had lower suction generation and release rates (p<0.0001), lower suction amplitude (p=0.004), longer suction duration (p<0.0001) and higher milk ejection pressure (p<0.0001). Conclusion The coordination of unique sucking and swallowing movement patterns may be achieved by the infant adapting to the sucking kinematics around the lingual patterns that facilitate the pharyngeal swallow.

Defining pharyngeal contractile integral during high-resolution manometry in neonates: a neuromotor marker of pharyngeal vigor

“…Solid state HRM [Solar GI, HRM Laborie Medical Technologies, Mississauga, ON, Canada] concurrent with provocative pharyngeal manometric and oral feeding methods were adapted (3, 4, 9, 12, 16, 28). Catheters included solid state HRM catheter (6 French) with 25 uni-directional pressure sensors spaced 1 cm apart (Unitip High Resolution Catheter, Unisensor, Portsmouth, NH) for pharyngo-esophageal motility, and a custom designed 5.25 French silastic catheter (Dentsleeve International, Mui Scientific, Mississauga, ON, Canada) for pharyngeal infusions.…”

“…Pharyngeal swallowing functions include pharyngeal rhythm kinetics, contractile force dynamics, regulatory modulation, and cross-systems interactions across the neuro-aero-digestive systems. Robust pharyngeal contractility is essential to trigger pharyngo-esophageal peristalsis when pharyngeal provocation occurs through oral feeding or during gastroesophageal reflux (GER) events (12-14).…”

Non-Nutritive Suckling System for Real-Time Characterization of Intraoral Vacuum Profile in Full Term Neonates

“…Referring to Fig. 2, one suck cycle is defined as having a minimum suck amplitude of 10 mmHg based on reported definitions in the literature [40]. These values are used to establish the threshold of the peak-valley detection algorithm.…”

Neonatal Feeding Behavior as a Complex Dynamical System

“…Modifications to the kinematics of sucking enable greater stability within the physiology of the pharyngeal swallow, facilitating safe bolus passage. 41 Providing small amounts of breast milk or formula on a pacifier or finger promotes exploration of milk or formula taste, a means for establishing informational coupling to guide sucking. 42 Consistent with a dynamical systems view, there are now subjective diagnostic assessment tools that describe physiological and behavioral parameters of "infant-driven," or responsive feeding in determining readiness to initiate oral feeding.…”