The effect of preterm birth, recurrent laryngeal nerve lesion, and postnatal maturation on hyoid and thyroid movements, and their coordination in infant feeding
The effect of preterm birth, recurrent laryngeal nerve lesion, and postnatal maturation on hyoid and thyroid movements, and their coordination in infant feeding
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DOI：
10.1016/j.jbiomech.2020.109786
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发表时间：
2020-05-22
影响因子：
2.4
通讯作者：
German，Rebecca Z.
中科院分区：
文献类型：
--
作者：
Mayerl，Christopher J.;Catchpole，Emily A.;German，Rebecca Z.
舌骨和甲状腺的运动对进食至关重要。这些结构通常被认为是同步移动的，尽管有证据表明神经受损的人群表现出改变的运动学。早产儿被广泛认为是一种神经系统受损的人群，经常经历喂养困难，但衡量表现，以及如何在儿科人群中表现成熟是具有挑战性的。为了保证早产儿的生存而进行的外科手术，如在动脉导管未闭矫正手术中对喉返神经（RLN）的损伤，常常使喂养问题复杂化。在这里，我们使用一个经过验证的仔猪模型进行婴儿喂养，以测试早产、产后成熟和RLN病变如何相互作用，影响舌骨和甲状腺偏移及其协调。我们在7日龄（相当于人类1-2个月）和17日龄（相当于人类6-9个月）的仔猪喂养时使用荧光录像拍摄，并在这两天追踪舌骨和甲状腺的运动。我们发现早产影响舌骨和甲状腺运动之间的协调，但不是它们的实际偏移。相比之下，足月猪和早产儿这两个结构的偏移随出生年龄的增加而增加。RLN病变减少甲状腺偏移，并主要通过增加舌骨偏移变化影响舌骨运动。这项研究表明，RLN病变和早产对婴儿的喂养表现有明显但普遍的影响，并建议针对减少吞咽困难的干预措施应根据导致吞咽困难的病因而不是吞咽困难的预后来制定。
Movements of the hyoid and thyroid are critical for feeding. These structures are often assumed to move in synchrony, despite evidence that neurologically compromised populations exhibit altered kinematics. Preterm infants are widely considered to be a neurologically compromised population and often experience feeding difficulties, yet measuring performance, and how performance matures in pediatric populations is challenging. Feeding problems are often compounded by complications arising from surgical procedures performed to ensure the survival of preterm infants, such as damage to the recurrent laryngeal nerve (RLN) during patent ductus arteriosus correction surgery. Here, we used a validated infant pig model for infant feeding to test how preterm birth, postnatal maturation, and RLN lesion interact to impact hyoid and thyroid excursion and their coordination. We filmed infant pigs when feeding using videofluorscopy at seven days old (1–2 months human equivalent) and 17 days old (6–9 months human equivalent) and tracked movements of the hyoid and thyroid on both days. We found that preterm birth impacted the coordination between hyoid and thyroid movements, but not their actual excursion. In contrast, excursion of the two structures increased with postnatal age in term and preterm pigs. RLN lesion decreased thyroid excursion, and primarily impacted hyoid movements by increasing variation in hyoid excursion. This work demonstrates that RLN lesion and preterm birth have distinct, but pervasive effects on feeding performance in infants, and suggest that interventions targeted towards reducing dysphagia should be prescribed based off the etiology driving dysphagia, rather than the prognosis of dysphagia.