Pilot Study of Pharyngoesophageal Dysmotility Mechanisms in Dysphagic Infants of Diabetic Mothers

Manish B. Malkar; Sreekanth K. Viswanathan; Sudarshan R. Jadcherla

doi:10.1055/s-0038-1676632

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(12): 1237-1242
DOI: 10.1055/s-0038-1676632

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pilot Study of Pharyngoesophageal Dysmotility Mechanisms in Dysphagic Infants of Diabetic Mothers

Manish B. Malkar

¹Division of Pediatric Cardiology, Department of Pediatrics, St. Louis University, St. Louis, Missouri

,

Sreekanth K. Viswanathan

²Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio

³Innovative Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio

,

Sudarshan R. Jadcherla

²Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio

³Innovative Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio

› Author Affiliations

Abstract

Objective Swallowing difficulties are common in infants of diabetic mothers (IDM) and mechanisms are unclear. We tested the hypothesis that pharyngoesophageal motility reflexes are distinct in IDMs compared with healthy controls in a pilot study.

Study Design Basal and adaptive pharyngoesophageal motility characteristics of 20 dysphagic IDMs and 10 controls were studied using purpose-built micromanometry system.

Results During basal swallows, IDMs had lower frequency of deglutition apneas (62.5 vs. 95.4%) and longer active upper esophageal sphincter (UES) relaxation duration (0.8 ± 0.1 vs. 0.4 ± 0.1 second), whereas during adaptive swallows, IDMs had longer response latency to esophageal peristalsis onset (24.4 ± 2.1 vs. 9.7 ± 2.9 seconds) and longer lower esophageal sphincter nadir duration (28.9 ± 3.2 vs. 12.9 ± 4.6) (all p < 0.05) compared with controls. Nine in the IDM group needed gastrostomy feeding tube at hospital discharge versus none in controls.

Conclusion Feeding difficulties in IDMs are likely to be associated with maladapted or maldeveloped vagal neuropathy mechanisms manifesting as dysregulation of pharyngeal–airway interactions, longer active UES relaxation response, delays in the activation of esophageal contractile apparatus during peristalsis, and prolonged inhibition at the gastroesophageal junction.

Keywords

infants of diabetic mothers - esophageal motility - dysphagia

Full Text

References

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