Effect of Nasal Non-Invasive Respiratory Support Methods on Pharyngeal Provocation Induced Aero-digestive Reflexes in Infants.

Effect of Nasal Non-Invasive Respiratory Support Methods on Pharyngeal Provocation Induced Aero-digestive Reflexes in Infants.

Am J Physiol Gastrointest Liver Physiol. 2016 Mar 24;:ajpgi.00307.2015

Authors: Jadcherla SR, Hasenstab KA, Sitaram S, Clouse BJ, Slaughter JL, Shaker R

Abstract
BACKGROUND AND OBJECTIVES: The pharynx is a locus of provocation among infants with aero-digestive morbidities manifesting as dysphagia, life-threatening events, aspiration-pneumonia, atelectasis and reflux, and such infants often receive nasal respiratory support. We determined the impact of different oxygen delivery methods on pharyngeal-stimulation induced aero-digestive reflexes (room air, RA; nasal cannula, NC; and nasal continuous positive airway pressure, nCPAP) while hypothesizing that the sensory-motor characteristics of putative reflexes are distinct.
METHODS: 38 infants (28.0 ± 0.7 wks gestation) underwent pharyngo-esophageal manometry and respiratory inductance plethysmography to determine the effects of graded pharyngeal stimuli (N=271) on upper and lower esophageal sphincters (UES, LES), swallowing, and deglutition-apnea. Comparisons were made between NC (N=19), nCPAP (N=9), and RA (N=10) groups.
RESULTS: Importantly, NC or nCPAP (vs. RA) had:1) delayed feeding milestones (P<0.05), 2) increased pharyngeal waveform recruitment and duration, greater UES nadir pressure, decreased esophageal contraction duration, decreased distal esophageal contraction amplitude, and decreased completely propagated esophageal peristalsis (all P < 0.05), and 3) similarly developed UES contractile and LES relaxation reflexes (P>0.05).
CONCLUSIONS: Aero-digestive reflexes were similarly developed in infants utilizing non-invasive respiratory support with adequate upper and lower aero-digestive protection. Increased concern for GERD is unfounded in this population. These infants may benefit from targeted oromotor feeding therapies and safe pharyngeal bolus transit to accelerate feeding milestones.

PMID: 27012774 [PubMed - as supplied by publisher]

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