Ultrasound Imaging of Infant Swallowing During Breast-Feeding

Abstract

Coordination of infants' suck-swallow-breathing patterns is integral to safe and efficient feeding. However, assessment of these patterns is difficult and often invasive, particularly in breast-fed infants less than 4 months of age. The aims of this study were to develop an ultrasound approach to visualize swallowing in term breast-feeding infants and to determine the accuracy of ultrasound imaging of swallowing compared to respiratory inductive plethysmography (RIP). On ultrasound, the breast milk bolus was observed as a predominantly echogenic area moving inferiorly. Of the 388 swallows detected with ultrasound, 379 correlated with the swallow apneas detected by RIP (R(2) = 0.98). The mean duration of the swallow was 0.63 +/- 0.06 s. Ultrasound imaging is a noninvasive accurate method for detection of swallowing by visualization of movement of the milk bolus through the pharyngeal area of a breast-feeding infant. These techniques may potentially provide useful information for infants experiencing breast-feeding difficulties.

Detecting pharyngeal post-swallow residue by ultrasound examination: a case series.

“…There are some previous studies that clearly visualized the oropharyngeal anatomy including vocal folds and boluses in the oropharyngeal area by US examination [14][15][16][17]. The finding in this study that the pharyngeal residue was detected as a misty hyperechoic area above the vocal folds in US images that could be distinguished from the soft tissues around the vocal folds was consistent with these previous studies.…”

Longitudinal Changes in Suck-Swallow-Breathe, Oxygen Saturation, and Heart Rate Patterns in Term Breastfeeding Infants

“…A swallow was identified as a stable signal on the respiratory trace. 20 Sucks and pauses were classified as NS if milk flow was observed in the intra-oral cavity; nutritive pausing (NP) if the pause occurred directly after NS; NNS if no milk flow was observed in the intra-oral cavity on ultrasound; and non-nutritive pausing (NNP) for subsequent pauses ( Figure 1). 17 For each suck burst, burst type (NS/NNS), peak vacuum (mean minimum pressure, mmHg), baseline vacuum (mean maximum pressure, mmHg), suck rate (sucks/min), respiratory rate (breaths/min), suck burst duration (s), total burst duration (s), heart rate (beats per min), and oxygen saturation (%) were calculated.…”

Reliability and Validity of Swallows as a Measure of Breast Milk Intake in the First Days of Life

“…4,10 However, the quantities of colostrum in the first days postpartum are varied, and swallowing, found to be directly related to the quantity of fluid in the mouth, may be very quiet and difficult to detect. 11 Ultrasound studies 12 provide detailed descriptions of the patterns of swallowing and breathing during breastfeeding. 13 Term infants have been found to have more coordinated suck-swallow rhythms than preterm infants, with fewer apneic periods during swallowing.…”

“…An infant's ability to coordinate suck-swallow-breathe is essential for feeding safety and effectiveness. 12 Lau and Henning 14 conducted pre-and postweights on 1 pair of 2-month-old twins and found a significant strong positive correlation between swallow counts and weight gain (r = .92 and .98). Videotapes of these feeds were found to be effective and did not disrupt the feeding.…”