Advances with Neonatal Aerodigestive Science in the Pursuit of Safe Swallowing in Infants: Invited Review

Abstract

Feeding, swallowing and airway protection are three distinct entities. Feeding involves a process of sequential, neurosensory and neuromotor interactions of reflexes and behaviors facilitating ingestion. Swallowing involves anterograde bolus movement during oral-, pharyngeal- and esophageal phases of peristalsis into stomach. During these events, coordination with airway protection is vital for homeostasis in clearing any material away from airway vicinity. Neurological-airway-digestive inter-relationships are critical to the continuum of successful feeding patterns during infancy, either in health or disease. Neonatal feeding difficulties encompass a heterogeneous group of neurological, pulmonary and aerodigestive disorders that present with multiple signs posing as clinical conundrums. Significant research breakthroughs permitted understanding of vagal neural pathways and functional aerodigestive connectivity involved in regulating swallowing and aerodigestive functions either directly or indirectly by influencing the supra-nuclear regulatory centers and peripheral effector organs. These neurosensory and neuromotor pathways are influenced by pathologies during perinatal events, prematurity, inflammatory states and coexisting medical and surgical conditions. Approaches to clarify pathophysiologic mapping of aerodigestive interactions, as well as translating these discoveries into the development of personalized and simplified feeding strategies to advance child health are discussed in this review article.

Silent aspiration: Who is at risk?

“…One study of a broad pediatric population reported that 34% of children aspirated, with 81% displaying silent aspiration . Normal children may also aspirate, but the incidence of silent aspiration in normal neonates and infants is unknown due to the lack of reliable and easily testable markers needed to make a diagnosis . Despite this prevalence, little is known about which medical diagnoses may be associated with silent aspiration in children.…”

“…3 Normal children may also aspirate, but the incidence of silent aspiration in normal neonates and infants is unknown due to the lack of reliable and easily testable markers needed to make a diagnosis. 10 Despite this prevalence, little is known about which medical diagnoses may be associated with silent aspiration in children. As a result, guidelines on who should be evaluated for this condition have not been well established.…”

Secretion Management in Tracheostomized Infants using Unconventional Approaches and Outcomes: A Case Series

“…This highlights the need to have the technology and expertise to better understand aerodigestive connectivity and pathophysiology. 16 With both infants, limiting the amount of suctioning and providing oral stimulation not only improved secretion management from Time 1 to Time 2, but also allowed them to start working on their oral feeding skills. The ultimate goal for both cases is to achieve oral feeds.…”

Challenges to Eating, Swallowing, and Aerodigestive Functions in Infants: A Burning Platform That Needs Attention!

“…As such, the integrated regulatory function of eating-swallowing-aerodigestive protection is a process of development in continuum, and is co-dependent on the reciprocal interactions between the foregut and airway, and involves the neural circuitry from brain stem nuclei and higher centers. [10][11][12][13] Eating is a highly complex skill, which involves a preparatory phase, oral phase, pharyngeal phase, esophageal phase, and gastric phase. Upon full term normal birth, the majority of healthy neonates are capable of achieving independent, self-regulatory oral feeding skills and can adapt well to all these phases.…”