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Semin Speech Lang 2017; 38(02): 087-095
DOI: 10.1055/s-0037-1599106
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Breathing and Swallowing: The Next Frontier

Roxann Diez Gross
1   Department of Speech Therapy, The Children's Institute of Pittsburgh, Pittsburgh, Pennsylvania
,
Marybeth Trapani-Hanasewych
1   Department of Speech Therapy, The Children's Institute of Pittsburgh, Pittsburgh, Pennsylvania
› Author Affiliations
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Publication History

Publication Date:
21 March 2017 (online)

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Abstract

The anatomical overlap of the pathways for air passage and nutrition necessitate precise coordination between the two vital functions. Neuroanatomic structures in the brainstem for sucking, breathing, and swallowing are also in close proximity and must swiftly coordinate the processes. In a healthy neonate, the oropharyngeal experience and stimulation of early feeding enables respiratory control during suckling to develop. Despite wide variability among the methods used to investigate breathing and swallowing coordination in infancy, a consistent finding of postswallow exhalation has been reported. Postswallow exhalation is significant because the positive airflow of exhalation is believed to provide airway clearance. Preterm neonates and infants swallow during all phases of the respiratory cycle, but ultimately progress to the most commonly reported pattern, which is inhale-swallow-exhale. This pattern is similar to the adult pattern of exhale-swallow-exhale. Monitoring respiratory signals during nonnutritive sucking and early feeding may help to identify newborns with increased risk of aspiration and assist with clinical decision making.

Keywords

Neonate - infant - dysphagia - feeding - breathing-swallowing coordination
 

  • References

  • 1 Lau C. Development of infant oral feeding skills: what do we know?. Am J Clin Nutr 2016; 103 (2) 616S-621S
    CrossrefPubMedSearch in Google Scholar
  • 2 Boddy K, Dawes GS. Fetal breathing. Br Med Bull 1975; 31 (1) 3-7
    PubMedSearch in Google Scholar
  • 3 Sato M, Kanenishi K, Hanaoka U, Noguchi J, Marumo G, Hata T. 4D ultrasound study of fetal facial expressions at 20-24 weeks of gestation. Int J Gynaecol Obstet 2014; 126 (3) 275-279
    CrossrefPubMedSearch in Google Scholar
  • 4 de Vries JI, Visser GH, Prechtl HF. The emergence of fetal behaviour. II. Quantitative aspects. Early Hum Dev 1985; 12 (2) 99-120
    CrossrefPubMedSearch in Google Scholar
  • 5 Miller JL, Sonies BC, Macedonia C. Emergence of oropharyngeal, laryngeal and swallowing activity in the developing fetal upper aerodigestive tract: an ultrasound evaluation. Early Hum Dev 2003; 71 (1) 61-87
    CrossrefPubMedSearch in Google Scholar
  • 6 Bautista TG, Sun QJ, Pilowsky PM. The generation of pharyngeal phase of swallow and its coordination with breathing: interaction between the swallow and respiratory central pattern generators. Prog Brain Res 2014; 212: 253-275
    PubMedSearch in Google Scholar
  • 7 Bianchi AL, Gestreau C. The brainstem respiratory network: an overview of a half century of research. Respir Physiol Neurobiol 2009; 168 (1–2) 4-12
    CrossrefPubMedSearch in Google Scholar
  • 8 Caravagna C, Seaborn T. Oxygen sensing in early life. Lung 2016; 194 (5) 715-722
    CrossrefPubMedSearch in Google Scholar
  • 9 Abu-Shaweesh JM. Maturation of respiratory reflex responses in the fetus and neonate. Semin Neonatol 2004; 9 (3) 169-180
    CrossrefPubMedSearch in Google Scholar
  • 10 Koenig JS, Davies AM, Thach BT. Coordination of breathing, sucking, and swallowing during bottle feedings in human infants. J Appl Physiol (1985) 1990; 69 (5) 1623-1629
    PubMedSearch in Google Scholar
  • 11 Bamford O, Taciak V, Gewolb IH. The relationship between rhythmic swallowing and breathing during suckle feeding in term neonates. Pediatr Res 1992; 31 (6) 619-624
    CrossrefPubMedSearch in Google Scholar
  • 12 Gewolb IH, Vice FL. Maturational changes in the rhythms, patterning, and coordination of respiration and swallow during feeding in preterm and term infants. Dev Med Child Neurol 2006; 48 (7) 589-594
    CrossrefPubMedSearch in Google Scholar
  • 13 Capilouto GJ, Cunningham T, Frederick E, Dupont-Versteegden E, Desai N, Butterfield TA. Comparison of tongue muscle characteristics of preterm and full term infants during nutritive and nonnutritive sucking. Infant Behav Dev 2014; 37 (3) 435-445
    CrossrefPubMedSearch in Google Scholar
  • 14 Mizuno K, Ueda A. The maturation and coordination of sucking, swallowing, and respiration in preterm infants. J Pediatr 2003; 142 (1) 36-40
    CrossrefPubMedSearch in Google Scholar
  • 15 Kelly BN, Huckabee ML, Jones RD, Frampton CM. The first year of human life: coordinating respiration and nutritive swallowing. Dysphagia 2007; 22 (1) 37-43
    CrossrefPubMedSearch in Google Scholar
  • 16 Goldfield EC, Richardson MJ, Lee KG, Margetts S. Coordination of sucking, swallowing, and breathing and oxygen saturation during early infant breast-feeding and bottle-feeding. Pediatr Res 2006; 60 (4) 450-455
    CrossrefPubMedSearch in Google Scholar
  • 17 Kelly BN, Huckabee ML, Jones RD, Frampton CM. The early impact of feeding on infant breathing-swallowing coordination. Respir Physiol Neurobiol 2007; 156 (2) 147-153
    CrossrefPubMedSearch in Google Scholar
  • 18 Reynolds EW, Grider D, Caldwell R , et al. Swallow-breath interaction and phase of respiration with swallow during nonnutritive suck among low-risk preterm infants. Am J Perinatol 2010; 27 (10) 831-840
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Lieberman DE, McCarthy RC, Hiiemae KM, Palmer JB. Ontogeny of postnatal hyoid and larynx descent in humans. Arch Oral Biol 2001; 46 (2) 117-128
    CrossrefPubMedSearch in Google Scholar
  • 20 Mizuno K, Ueda A, Takeuchi T. Effects of different fluids on the relationship between swallowing and breathing during nutritive sucking in neonates. Biol Neonate 2002; 81 (1) 45-50
    CrossrefPubMedSearch in Google Scholar
  • 21 Hårdemark Cedborg AI, Sundman E, Bodén K , et al. Co-ordination of spontaneous swallowing with respiratory airflow and diaphragmatic and abdominal muscle activity in healthy adult humans. Exp Physiol 2009; 94 (4) 459-468
    CrossrefPubMedSearch in Google Scholar
  • 22 Hårdemark Cedborg AI, Bodén K, Witt Hedström H , et al. Breathing and swallowing in normal man—effects of changes in body position, bolus types, and respiratory drive. Neurogastroenterol Motil 2010; 22 (11) 1201-1208 , e316
    CrossrefPubMedSearch in Google Scholar
  • 23 Martin-Harris B, Brodsky MB, Michel Y, Ford CL, Walters B, Heffner J. Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Head Neck Surg 2005; 131 (9) 762-770
    CrossrefPubMedSearch in Google Scholar
  • 24 Martin BJ, Logemann JA, Shaker R, Dodds WJ. Coordination between respiration and swallowing: respiratory phase relationships and temporal integration. J Appl Physiol (1985) 1994; 76 (2) 714-723
    PubMedSearch in Google Scholar
  • 25 Wheeler Hegland KM, Huber JE, Pitts T, Sapienza CM. Lung volume during swallowing: single bolus swallows in healthy young adults. J Speech Lang Hear Res 2009; 52 (1) 178-187
    CrossrefPubMedSearch in Google Scholar
  • 26 Lefton-Greif MA, Perlman AL, He X, Lederman HM, Crawford TO. Assessment of impaired coordination between respiration and deglutition in children and young adults with ataxia telangiectasia. Dev Med Child Neurol 2016; 58 (10) 1069-1075
    CrossrefPubMedSearch in Google Scholar
  • 27 Brochard L. Measurement of esophageal pressure at bedside: pros and cons. Curr Opin Crit Care 2014; 20 (1) 39-46
    CrossrefPubMedSearch in Google Scholar
  • 28 Irvin CG, Sampson M, Engel L, Grassino AE. Effect of breathing pattern on esophageal pressure gradients in humans. J Appl Physiol 1984; 57 (1) 168-175
    PubMedSearch in Google Scholar
  • 29 Hasenstab KA, Jadcherla SR. Respiratory events in infants presenting with apparent life threatening events: is there an explanation from esophageal motility?. J Pediatr 2014; 165 (2) 250-255.e1
    CrossrefPubMedSearch in Google Scholar
  • 30 Terrin G, Passariello A, De Curtis M , et al. Ranitidine is associated with infections, necrotizing enterocolitis, and fatal outcome in newborns. Pediatrics 2012; 129 (1) e40-e45
    CrossrefPubMedSearch in Google Scholar
  • 31 Nobile S, Noviello C, Cobellis G, Carnielli VP. Are infants with bronchopulmonary dysplasia prone to gastroesophageal reflux? A prospective observational study with esophageal pH-impedance monitoring. J Pediatr 2015; 167 (2) 279-85.e1
    CrossrefPubMedSearch in Google Scholar
  • 32 Gross RD, Atwood Jr CW, Ross SB, Olszewski JW, Eichhorn KA. The coordination of breathing and swallowing in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009; 179 (7) 559-565
    CrossrefPubMedSearch in Google Scholar
  • 33 Gross RD, Atwood Jr CW, Ross SB, Eichhorn KA, Olszewski JW, Doyle PJ. The coordination of breathing and swallowing in Parkinson's disease. Dysphagia 2008; 23 (2) 136-145
    CrossrefPubMedSearch in Google Scholar
  • 34 Rempel G, Moussavi Z. The effect of viscosity on the breath-swallow pattern of young people with cerebral palsy. Dysphagia 2005; 20 (2) 108-112
    CrossrefPubMedSearch in Google Scholar
  • 35 Pinnington LL, Muhiddin KA, Ellis RE, Playford ED. Non-invasive assessment of swallowing and respiration in Parkinson's disease. J Neurol 2000; 247 (10) 773-777
    CrossrefPubMedSearch in Google Scholar
  • 36 Troche MS, Huebner I, Rosenbek JC, Okun MS, Sapienza CM. Respiratory-swallowing coordination and swallowing safety in patients with Parkinson's disease. Dysphagia 2011; 26 (3) 218-224
    CrossrefPubMedSearch in Google Scholar
  • 37 Celli BR, Decramer M, Wedzicha JA , et al; ATS/ERS Task Force for COPD Research. An official American Thoracic Society/European Respiratory Society statement: research questions in COPD. Eur Respir Rev 2015; 24 (136) 159-172
    CrossrefPubMedSearch in Google Scholar
  • 38 Gross RD, Prigent H. Chronic obstructive pulmonary disease and occult aspiration: a review of the recent literature. Curr Phys Med Rehabil Rep 2015; 3 (4) 280-286
    CrossrefPubMedSearch in Google Scholar
  • 39 Sakae TM, Pizzichini MM, Teixeira PJ, Silva RM, Trevisol DJ, Pizzichini E. Exacerbations of COPD and symptoms of gastroesophageal reflux: a systematic review and meta-analysis. J Bras Pneumol 2013; 39 (3) 259-271
    CrossrefPubMedSearch in Google Scholar
  • 40 Day CL, Ryan RM. Bronchopulmonary dysplasia: new becomes old again!. Pediatr Res 2017; 81 (1–2) 210-213
    PubMedSearch in Google Scholar
  • 41 Gewolb IH, Vice FL. Abnormalities in the coordination of respiration and swallow in preterm infants with bronchopulmonary dysplasia. Dev Med Child Neurol 2006; 48 (7) 595-599
    CrossrefPubMedSearch in Google Scholar
  • 42 Barlow SM. Oral and respiratory control for preterm feeding. Curr Opin Otolaryngol Head Neck Surg 2009; 17 (3) 179-186
    CrossrefPubMedSearch in Google Scholar
  • 43 Sheikh S, Allen E, Shell R , et al. Chronic aspiration without gastroesophageal reflux as a cause of chronic respiratory symptoms in neurologically normal infants. Chest 2001; 120 (4) 1190-1195
    CrossrefPubMedSearch in Google Scholar
  • 44 Tutor JD, Srinivasan S, Gosa MM, Spentzas T, Stokes DC. Pulmonary function in infants with swallowing dysfunction. PLoS One 2015; 10 (5) e0123125
    CrossrefPubMedSearch in Google Scholar
  • 45 Brown JD, Doshi PA, Pauly NJ, Talbert JC. Rates of neonatal abstinence syndrome amid efforts to combat the opioid abuse epidemic. JAMA Pediatr 2016; 170 (11) 1110-1112
    CrossrefPubMedSearch in Google Scholar
  • 46 Gewolb IH, Fishman D, Qureshi MA, Vice FL. Coordination of suck-swallow-respiration in infants born to mothers with drug-abuse problems. Dev Med Child Neurol 2004; 46 (10) 700-705
    PubMedSearch in Google Scholar