Gestational and postnatal modulation of esophageal sphincter reflexes in human premature neonates

Jadcherla, Sudarshan R.; Shubert, Theresa; Malkar, Manish B.; Sitaram, Swetha; Moore, Rebecca; Wei, Lai; Fernández, Soledad; Castile, Robert G.

doi:10.1038/pr.2015.149

Cited by 15 publications

(10 citation statements)

References 43 publications

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“…Studies in humans have reported similar reflexes in response to slow esophageal distension in full-term and preterm infants (8,11,12,15,17) in addition to esophagoglottal closure in response to rapid esophageal distension in adults and full-term (50) and preterm infants (13,14).…”

Section: Literature Data On Reflexes Originating From the Esophagusmentioning

confidence: 88%

Reflex cardiorespiratory events from esophageal origin are heightened by preterm birth

Nault

Samson

Nadeau

et al. 2017

Journal of Applied Physiology

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The involvement of gastroesophageal refluxes in cardiorespiratory events of preterm infants remains controversial. While a few studies in full-term newborn animals have shown that stimulation of esophageal receptors leads to cardiorespiratory reflexes, the latter remain largely unknown, especially after premature birth. The present study aimed to ) characterize the cardiorespiratory reflexes originating from esophageal receptors in newborn lambs and) test the hypotheses that preterm birth enhances reflex cardiorespiratory inhibition and that C-fibers are involved in these reflexes. Eight full-term lambs and 10 lambs born 14 days prematurely were studied. Following surgical instrumentation, a 6-h polysomnography was performed without sedation to record electrocardiogram, respiratory movements, arterial pressure, laryngeal constrictor muscle activity, state of alertness, and hemoglobin oxygen saturation. Five esophageal stimulations of the upper and/or lower esophagus, including rapid balloon inflation and/or HCl injection, were performed in random order. A second recording was performed in full-term lambs 24 h later, after C-fiber blockade by capsaicin. Results confirmed that esophageal stimulations induced inhibitory cardiorespiratory reflexes combined with protective mechanisms, including laryngeal closure, swallowing, coughing, increased arterial pressure, and arousal. Preterm birth heightened cardiorespiratory inhibition. The strongest cardiorespiratory inhibition was observed following simultaneous stimulation of the lower and upper esophagus. Finally, cardiorespiratory inhibition was decreased after C-fiber blockade. In conclusion, esophageal stimulation induces inhibitory cardiorespiratory reflexes, which are partly mediated by C-fibers and more pronounced in preterm lambs. Clinical relevance of these findings requires further studies, especially in conditions associated with increased cardiorespiratory events, e.g., neonatal infection. Preterm birth heightens the cardiorespiratory events triggered by esophageal stimulation. The most extensive cardiorespiratory events are induced by simultaneous stimulation of the proximal and distal esophagus.

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Section: Literature Data On Reflexes Originating From the Esophagusmentioning

confidence: 88%

Reflex cardiorespiratory events from esophageal origin are heightened by preterm birth

Nault

Samson

Nadeau

et al. 2017

Journal of Applied Physiology

View full text Add to dashboard Cite

show abstract

“…In the past, maturational changes of the LES function have been explored during dry swallows and in response to mid-esophageal provocations [11, 14, 28]. Pena et al [14] demonstrated shorter response latency to LES relaxation in response to liquid stimulation and longer LES relaxation in relation to age.…”

Section: Discussionmentioning

confidence: 99%

Maturation of Esophageal Motility and Esophagogastric Junction in Preterm Infants

et al. 2020

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Background: Preterm infants commonly present with oral feeding problems. The role of maturation of esophageal bolus transport mechanisms herein remains unclear. Objectives: To characterize esophageal motility and function of esophagogastric junction (EGJ) during deglutitive swallowing in healthy preterm infants and to describe maturational changes. Methods: Four consecutive high-resolution manometry studies with impedance studies were performed weekly to investigate esophageal motility and EGJ function. Esophageal pressure topography and pressureimpedance metrics were derived. Mixed models with repeated measures were used for statistical analysis. Results: We analyzed 137 nutritive swallows from 36 motility studies in 10 preterm infants. The mean gestational age was

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“…Additionally, all subjects were former preterm infants. While pharyngo‐esophageal motility does mature with increasing age, former preterm infants studied at term equivalent PMA have esophageal motility skills approaching those of infants born at term gestation . Therefore, the results are directly applicable to former preterm born infants when they reach term PMA, however, it is also appropriate to extrapolate the results as applicable as well to infants born at term gestation .…”

Section: Discussionmentioning

confidence: 99%

“…50,51 Therefore, the results are directly applicable to former preterm born infants when they reach term PMA, however, it is also appropriate to extrapolate the results as applicable as well to infants born at term gestation. 50,51 As has been demonstrated for manometry analysis algorithms using Chicago Classification in adults, when dealing with a pediatric or neonatal population, modifications are necessary to account for changing parameters with patient age and size [19][20][21] ; however, the precise application of these adjustments is unknown for neonates. Our finding that the majority of the swallows analyzed fell into the 'weak' category for contractile vigor, despite the majority characterization of completeness of peristaltic wave, may indicate that modification indeed may be necessary in neonates for such categories.…”

Section: Discussionmentioning

confidence: 99%

“…While pharyngo‐esophageal motility does mature with increasing age, former preterm infants studied at term equivalent PMA have esophageal motility skills approaching those of infants born at term gestation . Therefore, the results are directly applicable to former preterm born infants when they reach term PMA, however, it is also appropriate to extrapolate the results as applicable as well to infants born at term gestation . As has been demonstrated for manometry analysis algorithms using Chicago Classification in adults, when dealing with a pediatric or neonatal population, modifications are necessary to account for changing parameters with patient age and size; however, the precise application of these adjustments is unknown for neonates.…”

Section: Discussionmentioning

confidence: 99%

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

Shubert

Sitaram

Jadcherla

2016

Neurogastroenterology Motil

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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.

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Gestational and postnatal modulation of esophageal sphincter reflexes in human premature neonates

Cited by 15 publications

References 43 publications

Reflex cardiorespiratory events from esophageal origin are heightened by preterm birth

Reflex cardiorespiratory events from esophageal origin are heightened by preterm birth

Maturation of Esophageal Motility and Esophagogastric Junction in Preterm Infants

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

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