Download PDF
Am J Perinatol 2010; 27(10): 831-840
DOI: 10.1055/s-0030-1262504
© Thieme Medical Publishers

Swallow–Breath Interaction and Phase of Respiration with Swallow during Nonnutritive Suck among Low-risk Preterm Infants

Eric W. Reynolds1 , Debbie Grider1 , Rhonda Caldwell1 , Gilson Capilouto2 , Pooja Vijaygopal3 , Abhijit Patwardhan3 , Richard Charnigo4
  • 1Division of Neonatology, Kentucky Children's Hospital, Lexington, Kentucky
  • 2Division of Communication Sciences and Disorders, Lexington, Kentucky
  • 3Center for Biomedical Engineering, Lexington, Kentucky
  • 4Department of Biostatistics, University of Kentucky, Lexington, Kentucky
Further Information

Publication History

Publication Date:
06 July 2010 (online)

Also available at
   Permissions and Reprints

ABSTRACT

This study describes swallow–breath interaction and phase of respiration with swallow during nonnutritive suck (NNS) in low-risk preterm infants. Suckle and swallow, thoracic motion, and airflow were measured in 16 infants during NNS. Logistic regression models were used to describe swallow–breath interaction and phase of respiration with swallow. One hundred seventy-six swallows occurred in 35 NNS periods. Swallow–breath interaction occurred as: central apnea (CA), obstructive apnea (OA), or attenuated respiration (AR). AR was associated with increased weeks post–first nipple feeding. OA occurred less often in males and with increased weeks post–first nipple feeding. In looking at the phase of respiration, more swallows occurred at beginning expiration with increased gestational age, increased weeks post–first nipple feed, and increased weeks before first nipple feed. More swallows occurred at midexpiration with more swallows per study, increased birth weight (BWT), and weeks before first nipple feed. Fewer swallows occurred at end expiration with increased weeks before first nipple feed. Fewer swallows occurred at midinspiration with increased swallows per study. Fewer swallows occurred at apnea with increasing BWT, more occurred with increased swallows per study. In low-risk preterm infants, swallow–breath interaction progresses from CA and OA to AR. The phase of respiration with swallow shows a maturation progression.

KEYWORDS

Nonnutritive suck - feeding behavior

REFERENCES

  • 1 Bennett F C. Neurodevelopmental outcome in low birthweight infants: the role of developmental intervention. In: Guthrie R Clinics in Critical Care Medicine No. 13: Neonatal Intensive Care. New York; Churchill Livingstone 1988: 221-249
    PubMedSearch in Google Scholar
  • 2 Ingram T TS. Clinical significance of the infantile feeding reflexes.  Dev Med Child Neurol. 1962;  4 159-169
    CrossrefPubMedSearch in Google Scholar
  • 3 Volpe J J, Hill H. Disorders of sucking and swallowing in the newborn infant: clinicopathological correlations. In: Korofiken R, Guilleminault C Progress in Perinatal Neurology. Vol. 1. Baltimore; Williams & Wilkins 1981: 157-181
    PubMedSearch in Google Scholar
  • 4 Mizuno K, Ueda A. Neonatal feeding performance as a predictor of neurodevelopmental outcome at 18 months.  Dev Med Child Neurol. 2005;  47 299-304
    CrossrefPubMedSearch in Google Scholar
  • 5 VandenBerg K A. Nippling management of the sick neonate in the NICU: the disorganized feeder.  Neonatal Netw. 1990;  9 9-16
    PubMedSearch in Google Scholar
  • 6 Comrie J D, Helm J M. Common feeding problems in the intensive care nursery: maturation, organization, evaluation, and management strategies.  Semin Speech Lang. 1997;  18 239-260 quiz 261
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Rommel N, De Meyer A M, Feenstra L, Veereman-Wauters G. The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution.  J Pediatr Gastroenterol Nutr. 2003;  37 75-84
    Search in Google Scholar
  • 8 Humphrey T. Reflex activity in the oral and facial area of the human fetus. In Bosma JF Second Symposium on Oral Sensation and Perception. Springfield, IL; Thomas 1970: 195
    PubMedSearch in Google Scholar
  • 9 Golubeva E L, Shuleikina K V, Vainstein I I. The development of reflex and spontaneous activity of the human fetus during embryogenesis.  Obstet Gynecol (USSR). 1959;  3 59-62
    PubMedSearch in Google Scholar
  • 10 Bosma J F. Development and impairments of feeding in infancy and childhood. In Groher ME Dysphagia: Diagnosis and Management, 3rd ed. Boston; Butterworth-Heinemann 1997: 131-167
    PubMedSearch in Google Scholar
  • 11 Illingworth R S, Lister J. The critical or sensitive period, with special reference to certain feeding problems in infants and children.  J Pediatr. 1964;  65 839-848
    CrossrefPubMedSearch in Google Scholar
  • 12 Volpe J J. Hypoxic-ischemic encephalopathy: neuropathology and pathogenesis. In: Neurology of the Newborn, 3rd ed Philadelphia; WB Saunders 1995: 279-313
    PubMed
  • 13 Levene M I, Sands C, Grindulis H, Moore J R. Comparison of two methods of predicting outcome in perinatal asphyxia.  Lancet. 1986;  1 67-69
    PubMedSearch in Google Scholar
  • 14 Qureshi M A, Vice F L, Taciak V L, Bosma J F, Gewolb I H. Changes in rhythmic suckle feeding patterns in term infants in the first month of life.  Dev Med Child Neurol. 2002;  44 34-39
    CrossrefPubMedSearch in Google Scholar
  • 15 Stevenson R D, Allaire J H. The development of normal feeding and swallowing.  Pediatr Clin North Am. 1991;  38 1439-1453
    PubMedSearch in Google Scholar
  • 16 Barlow S M, Lund J P, Estep M, Kolta A. Central pattern generators for speech and orofacial activity. In: Bruzynski SM Handbook of Mammalian Vocalization. Oxford; Elsevier 2010: 351-370
    PubMedSearch in Google Scholar
  • 17 Doty R W. Neural organization of deglutition. In Code CF, Heidel W Handbook of Physiology. Section 6: Alimentary Canal. Washington DC; American Physiological Society 1965: 1861-1902
    PubMedSearch in Google Scholar
  • 18 Sumi T. Neuronal mechanisms of swallowing.  Pflugers Arch. 1964;  278 467-477
    CrossrefPubMedSearch in Google Scholar
  • 19 Bosma J F. Development of feeding.  Clin Nutr. 1986;  5 210-218
    PubMedSearch in Google Scholar
  • 20 Amri M, Car A, Roman C. Axonal branching of medullary swallowing neurons projecting on the trigeminal and hypoglossal motor nuclei: demonstration by electrophysiological and fluorescent double labeling techniques.  Exp Brain Res. 1990;  81 384-390
    PubMedSearch in Google Scholar
  • 21 Jean A. Brainstem control of swallowing: localization and organization of the central pattern generator for swallowing. In: Taylor A Neurophysiology of the Jaws and Teeth. London; MacMillan Press 1990: 294-321
    PubMedSearch in Google Scholar
  • 22 Bamford O, Taciak V, Gewolb I H. The relationship between rhythmic swallowing and breathing during suckle feeding in term neonates.  Pediatr Res. 1992;  31 619-624
    CrossrefPubMedSearch in Google Scholar
  • 23 Gewolb I H, Vice F L. Maturational changes in the rhythms, patterning, and coordination of respiration and swallow during feeding in preterm and term infants.  Dev Med Child Neurol. 2006;  48 589-594
    CrossrefPubMedSearch in Google Scholar
  • 24 Gewolb I H, Vice F L. Abnormalities in the coordination of respiration and swallow in preterm infants with bronchopulmonary dysplasia.  Dev Med Child Neurol. 2006;  48 595-599
    CrossrefPubMedSearch in Google Scholar
  • 25 Liang K Y, Zeger S. Longitudinal data analysis using generalized linear models.  Biometrika. 1986;  73 13-22
    CrossrefPubMedSearch in Google Scholar
  • 26 Sanders-Phillips K. Infant feeding behavior and caretaker-infant relationships in black families.  J Comp Fam Stud. 1998;  29 161-171
    PubMedSearch in Google Scholar
  • 27 Agras W S, Kraemer H C, Berkowitz R I, Korner A F, Hammer L D. Does a vigorous feeding style influence early development of adiposity?.  J Pediatr. 1987;  110 799-804
    PubMedSearch in Google Scholar
  • 28 Dubignon J, Cooper D. Good and poor feeding behavior in the neonatal period.  Infant Behav Dev. 1980;  3 395-408
    CrossrefPubMedSearch in Google Scholar
  • 29 Bernbaum J C, Pereira G R, Watkins J B, Peckham G J. Nonnutritive sucking during gavage feeding enhances growth and maturation in premature infants.  Pediatrics. 1983;  71 41-45
    PubMedSearch in Google Scholar
  • 30 Lau C, Sheena H R, Shulman R J, Schanler R J. Oral feeding in low birth weight infants.  J Pediatr. 1997;  130 561-569
    CrossrefPubMedSearch in Google Scholar
  • 31 Lau C, Alagugurusamy R, Schanler R J, Smith E O, Shulman R J. Characterization of the developmental stages of sucking in preterm infants during bottle feeding.  Acta Paediatr. 2000;  89 846-852
    CrossrefPubMedSearch in Google Scholar
  • 32 Lau C, Kusnierczyk I. Quantitative evaluation of infant's nonnutritive and nutritive sucking.  Dysphagia. 2001;  16 58-67
    CrossrefPubMedSearch in Google Scholar
  • 33 Lau C, Smith E O, Schanler R J. Coordination of suck-swallow and swallow respiration in preterm infants.  Acta Paediatr. 2003;  92 721-727
    CrossrefPubMedSearch in Google Scholar
  • 34 Lau C. Oral feeding in the preterm infant.  NeoReviews. 2006;  7 e19-e27
    CrossrefPubMedSearch in Google Scholar
  • 35 Braun M, Palmer M. A pilot study of oral-motor dysfunction in “at risk” infants.  Phys Occup Ther Pediatr. 1986;  5 13-25
    PubMedSearch in Google Scholar
  • 36 Liu J, Bann C, Lester B et al.. Neonatal neurobehavior predicts medical and behavioral outcome.  Pediatrics. 2010;  125 e90-e98
    CrossrefPubMedSearch in Google Scholar
  • 37 Tsai S W, Chen C H, Lin M C. Prediction for developmental delay on Neonatal Oral Motor Assessment Scale in preterm infants without brain lesion.  Pediatr Int. 2010;  52 65-68
    CrossrefPubMedSearch in Google Scholar
  • 38 Burroughs A K, Asonye U O, Anderson G C, Vidyasager D. The effect of nonnutritive sucking on transcutaneous oxygen tension in noncrying, preterm infants.  Research in Nursing and Health Care. 1978;  1 69-75
    PubMedSearch in Google Scholar
  • 39 Nading J H, Landes R D. Oxygen tension due to nonnutritive sucking during orogastric tube feeding.  Pediatr Res. 1984;  18 206A
    PubMedSearch in Google Scholar
  • 40 Lappi H, Valkonen-Korhonen M, Georgiadis S et al.. Effects of nutritive and non-nutritive sucking on infant heart rate variability during the first 6 months of life.  Infant Behav Dev. 2007;  30 546-556
    CrossrefPubMedSearch in Google Scholar
  • 41 Woodson R, Hamilton C. The effect of nonnutritive sucking on heart rate in preterm infants.  Dev Psychobiol. 1988;  21 207-213
    CrossrefPubMedSearch in Google Scholar
  • 42 Measel C P, Anderson G C. Nonnutritive sucking during tube feedings: effect on clinical course in premature infants.  JOGN Nurs. 1979;  8 265-272
    PubMedSearch in Google Scholar
  • 43 Field T, Ignatoff E, Stringer S et al.. Nonnutritive sucking during tube feedings: effects on preterm neonates in an intensive care unit.  Pediatrics. 1982;  70 381-384
    PubMedSearch in Google Scholar
  • 44 Bernbaum J C. Medical care after discharge. In: Avery GB, Fletcher MA, MacDonald MG Neonatology: Pathophysiology and Management of the Newborn, 5th ed. Philadelphia; Lippincott Williams & Wilkins 1999: 1463-1476
    PubMedSearch in Google Scholar
  • 45 Barlow S M, Finan D S, Lee J, Chu S. Synthetic orocutaneous stimulation entrains preterm infants with feeding difficulties to suck.  J Perinatol. 2008;  28 541-548
    CrossrefPubMedSearch in Google Scholar
  • 46 Rocha A D, Moreira M E, Pimenta H P, Ramos J R, Lucena S L. A randomized study of the efficacy of sensory-motor-oral stimulation and non-nutritive sucking in very low birthweight infant.  Early Hum Dev. 2007;  83 385-388
    CrossrefPubMedSearch in Google Scholar
  • 47 Fucile S, Gisel E, Lau C. Oral stimulation accelerates the transition from tube to oral feeding in preterm infants.  J Pediatr. 2002;  141 230-236
    CrossrefPubMedSearch in Google Scholar
  • 48 Fucile S, Gisel E G, Lau C. Effect of an oral stimulation program on sucking skill maturation of preterm infants.  Dev Med Child Neurol. 2005;  47 158-162
    CrossrefPubMedSearch in Google Scholar
  • 49 Mathew O P, Clark M L, Pronske M H. Breathing pattern of neonates during nonnutritive sucking.  Pediatr Pulmonol. 1985;  1 204-206
    CrossrefPubMedSearch in Google Scholar
  • 50 Paydarfar D, Gilbert R J, Poppel C S, Nassab P F. Respiratory phase resetting and airflow changes induced by swallowing in humans.  J Physiol. 1995;  483(Pt 1) 273-288
    PubMedSearch in Google Scholar
  • 51 Clark G A. Deglutition apnoea.  J Physiol. 1920;  54 59
    PubMedSearch in Google Scholar
  • 52 Gewolb I H, Bosma J F, Taciak V L, Vice F L. Abnormal developmental patterns of suck and swallow rhythms during feeding in preterm infants with bronchopulmonary dysplasia.  Dev Med Child Neurol. 2001;  43 454-459
    CrossrefPubMedSearch in Google Scholar
  • 53 Gewolb I H, Vice F L, Schwietzer-Kenney E L, Taciak V L, Bosma J F. Developmental patterns of rhythmic suck and swallow in preterm infants.  Dev Med Child Neurol. 2001;  43 22-27
    CrossrefPubMedSearch in Google Scholar
  • 54 Gewolb I H, Bosma J F, Vice F L. Maturational changes in the coordination of respiration and swallow in premature infants with and without bronchopulmonary dysplasia (BPD).  Pediatr Res. 2002;  51 321A , (Abstract)
    PubMedSearch in Google Scholar
  • 55 Gewolb I H, Bosma J F, Reynolds E W, Vice F L. Integration of suck and swallow rhythms during feeding in preterm infants with and without bronchopulmonary dysplasia.  Dev Med Child Neurol. 2003;  45 344-348
    CrossrefPubMedSearch in Google Scholar
  • 56 Wilson S L, Thach B T, Brouillette R T, Abu-Osba Y K. Coordination of breathing and swallowing in human infants.  J Appl Physiol. 1981;  50 851-858
    PubMedSearch in Google Scholar
  • 57 Nixon G M, Charbonneau I, Kermack A S, Brouillette R T, McFarland D H. Respiratory-swallowing interactions during sleep in premature infants at term.  Respir Physiol Neurobiol. 2008;  160 76-82
    CrossrefPubMedSearch in Google Scholar
  • 58 Lau C, Smith E O, Schanler R J. Coordination of suck-swallow and swallow respiration in preterm infants.  Acta Paediatr. 2003;  92 721-727
    CrossrefPubMedSearch in Google Scholar
  • 59 Nishino T, Yonezawa T, Honda Y. Effects of swallowing on the pattern of continuous respiration in human adults.  Am Rev Respir Dis. 1985;  132 1219-1222
    PubMedSearch in Google Scholar
  • 60 Preiksaitis H G, Mayrand S, Robins K, Diamant N E. Coordination of respiration and swallowing: effect of bolus volume in normal adults.  Am J Physiol. 1992;  263(3 Pt 2) R624-R630
    PubMedSearch in Google Scholar
  • 61 Shaker R, Li Q, Ren J et al.. Coordination of deglutition and phases of respiration: effect of aging, tachypnea, bolus volume, and chronic obstructive pulmonary disease.  Am J Physiol. 1992;  263 R750-R755
    PubMedSearch in Google Scholar
  • 62 Smith J, Wolkove N, Colacone A, Kreisman H. Coordination of eating, drinking and breathing in adults.  Chest. 1989;  96 578-582
    CrossrefPubMedSearch in Google Scholar

Eric W ReynoldsM.D. M.P.H. 

Division of Neonatology, Kentucky Children's Hospital

800 Rose St, MS 477, Lexington, KY 40536

Email: ereyn2@uky.edu