The Relationship between Rhythmic Swallowing and Breathing during Suckle Feeding in Term Neonates

Abstract

ABSTRACT. Little is known of the development of efficient coordination between suckle feeding and breathing in human infants. To establish baseline data, we recorded breathing and swallowing activity during bottle feeds in 23 infants at 14-48 h postnatal age. Most swallows (overall mean 68%) were organized into runs, with intervals starting at 0.6-0.8 s and slowing to 1-1.3 s after 30-40 s. The proportion of run swallows to total swallows increased significantly with age. Swallow intervals were regular (coefficient of variation = 18-38%) compared with breathing (coefficient of variation = 50%). Both breathing rate and tidal volume were significantly reduced by the onset of suckle feeding, and the pattern of respiratory airflow became markedly irregular. Mild transient desaturation was common, but was not accompanied by changes in heart rate. Swallows could occur in all phases of breathing. Overall, equal numbers of swallows were preceded by expiration and inspiration, but twice as many were followed by expiration compared with inspiration. Swallows were classified by the respiratory phases both preceding and following the swallow. Swallows occurred in all possible classifications in each of the infants studied. The incidence of the most frequent classification (inspiration-swallowexpiration), was 24% overall (individual range 5-50%). The phase relation between swallows and breaths changed frequently but showed occasional short periods of stability during which the breathing became regular and tidal volume increased. We conclude that at <48 h the normal infant has little coordination between swallowing and breathing rhythms and maintains rhythmic swallowing at the expense of eupnea. (Pediatr Res 31: 619-624,1992)

Sucking and swallowing in infants and diagnostic tools

“…On the other hand, age expressed in terms of PMA correlates better with the development of sucking and swallowing than chronological age, which presumes that oral feeding is a congenital behavioral pattern rather than acquired behavior. 28 Lau and Kusnierczyk 6 divided the normal maturational process into five primary stages based on the presence or absence of suction and rhythmicity for the two components of sucking: suction and expression/compression (Table 1). Lau and Kusnierczyk 6 used this scale to indicate the relation between the development of sucking and the preterm infant's oral feeding skill.…”

Effects of Different Fluids on the Relationship between Swallowing and Breathing during Nutritive Sucking in Neonates

“…This impression was confirmed by analysis of the feeding records. A run was defined as three or more swallows occurring at intervals of less than 2 s [10]. A swallowswallow interval of 2 s or more was considered to mark the end of a run.…”

“…On the other hand, Selley et al [2] reported that the predominant pattern was inspiration-swallow-expiration in 15 of 19 infants, and an average of 83% of swallows were followed by expiration. Bamford et al [10] examined the coordination between swallowing and breathing in the normal newborn infant at age less than 48 h. They found considerable variability in the phase relationship between swallows and breaths in early neonatal life.…”

“…A nasal thermistor bead assembly (522E, Anritsu, Tokyo, Japan), taped below one nostril, was used to detect air temperature (high on expiration, low on inspiration so that downward indicates inspiration and upward indicates expiration) [10]. This system has a rapid response to flow changes, but care is needed to distinguish the respiratory airflow from artifacts caused by temperature equilibration of the bead if the airflow stops.…”

“…To assess the relationship between swallowing and breathing, classification by its relationship to adjacent breaths was examined [10]. In brief, any swallow must be immediately preceded by inspiration (I) or expiration (E) airflow or by a pause (P) in which the airflow Fig.…”