Effects of pacifier and taste on swallowing, esophageal motility, transit, and respiratory rhythm in human neonates

Abstract

Background Pacifier use is widely prevalent globally despite hygienic concerns and uncertain mechanistic effects on swallowing or airway safety. Aims The effects of pacifier and taste interventions on pharyngo-esophageal motility, bolus transit and respiratory rhythms were investigated by determining the upper esophageal sphincter (UES), esophageal body, esophagogastric junction (EGJ) motor patterns as well as deglutition apnea, respiratory rhythm disturbances and esophageal bolus clearance. Methods Fifteen infants (6 males; median gestation 31 wks and birth weight 1.4 kg) underwent high resolution impedance manometry at 43 (41-44) weeks post-menstrual age. Manometric, respiratory, and impedance characteristics of spontaneous swallows, pacifier associated dry swallowing and taste (pacifier dipped in 3% sucrose) associated swallowing were analyzed. Linear mixed and generalized estimating equation models were used. Data are presented as mean ± SEM, %, or median (IQR). Key Results Pharyngo-esophageal motility, respiratory, and impedance characteristics of 209 swallows were analyzed (85 spontaneous swallows, 63 pacifier associated dry swallows, 61 taste associated swallows). Basal UES and EGJ pressures decreased upon pacifier (P<0.05) and taste interventions (P<0.05); however, esophageal motility, respiratory rhythm, and impedance transit characteristics were similar with both interventions. Conclusions and Inferences Oral stimulus with pacifier or taste interventions decreases UES and EGJ basal pressure, but has no effects on pharyngo-esophageal motility, airway interactions, or esophageal bolus transit. A decrease in central parasympathetic-cholinergic excitatory drive is likely responsible for the basal effects.

Anemia of Prematurity and Oral Feeding Milestones in Premature Infants

“…The effects of neurologic, cardiorespiratory, and aerodigestive factors on regulation of biorhythms involved with feeding safety need further longitudinal study in premature infants with evolving disease, such as neuropathology or BPD. Such studies should incorporate patient-specific bedside tools, such as highresolution manometry studies [32][33][34][35] or NIRS 12,36 to assess the compensatory mechanisms. If infants with severe AOP showing decompensation features with oral feeding attempts, effects of interventions (use of Erythropoietin and Darbepoetin), which also have neuroprotective effects, on prevention of AOP and oral feeding outcomes could be tested in future studies or as a secondary outcome in ongoing randomized trials.…”

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

“…Interventions with pacifiers have been shown to facilitate UES relaxation in swallowing and primary peristalsis by decreasing the cholinergic excitatory output to both the UES and lower esophageal sphincter via the vagus nerve. 15 The addition of taste intervention has also been shown to result in primary peristalsis rhythm sequences occurring more rapidly with rapid restoration of respiratory normalcy after completion of the primary peristalsis. 15 Both of our cases demonstrated an increase in primary peristalsis after providing them a fruit-based product.…”

“…15 The addition of taste intervention has also been shown to result in primary peristalsis rhythm sequences occurring more rapidly with rapid restoration of respiratory normalcy after completion of the primary peristalsis. 15 Both of our cases demonstrated an increase in primary peristalsis after providing them a fruit-based product.…”

Maturation Modulates Pharyngeal-Stimulus Provoked Pharyngeal and Respiratory Rhythms in Human Infants

“…While it has been shown that the oral, pharyngeal, and esophageal, phases of swallowing are independent of each other (2, 3), future work is needed to evaluate correlation of oromotor phases with pharyngeal and esophageal phases. Pharyngeal swallowing or UES contraction may be induced by oral, pharyngeal, esophageal, tussive, or gastroesophageal reflux stimuli (3, 5, 7, 17, 19–23, 27, 44–46). Thus, terminologies have been adopted to distinguish responses due to these specific testing conditions.…”