Swallow Safety is Determined by Bolus Volume During Infant Feeding in an Animal Model.
Swallow Safety is Determined by Bolus Volume During Infant Feeding in an Animal Model.
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DOI：
10.1007/s00455-020-10118-x
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发表时间：
2021-03
期刊：
影响因子：
2.6
通讯作者：
German RZ
中科院分区：
文献类型：
--
作者：
Mayerl CJ;Myrla AM;Gould FDH;Bond LE;Stricklen BM;German RZ
喂养困难在早产儿中尤其普遍，尽管由于缺乏健康婴儿的数据，导致这些困难的机制知之甚少。成人吞咽困难的一个潜在机制与推注量相关。然而，在婴儿喂养中，推注量是否以及如何影响吞咽安全性尚不清楚。安全婴儿吞咽的另一个并发症是由于动脉导管未闭手术导致的喉返神经（RLN）损伤，这加剧了早产儿面临的问题，并可能增加吞咽困难的风险。在这里，我们使用了一个有效的动物模型自由喂养，以测试早产，出生后成熟和喉返神经病变及其相互作用对吞咽安全性的影响。我们还测试了丸剂大小是否随病变或出生状态而不同，以及丸剂大小与吞咽安全性之间的关系。我们发现病变对吞咽安全性的影响很小，早产儿并没有比足月儿经历更多的穿透或吸入。然而，即使在校正了体型之后，足月儿也比早产儿吞咽了更大的推注。丸剂大小是穿透或吸入的主要预测因素，无论年龄或病变状态如何，较大的丸剂更可能导致更严重的吞咽困难。这些结果强调，渗透和吸入可能是正常发生的婴儿喂养。此外，当存在合并症（如RLN病变或早产）时，限制推注剂量可能是降低穿透和吸入发生率的有效方法。
Feeding difficulties are especially prevalent in preterm infants, although the mechanisms driving these difficulties are poorly understood due to a lack of data on healthy infants. One potential mechanism of dysphagia in adults is correlated with bolus volume. Yet, whether and how bolus volume impacts swallow safety in infant feeding is unknown. A further complication for safe infant swallowing is recurrent laryngeal nerve (RLN) injury due to patent ductus arteriosus surgery, which exacerbates the issues that preterm infants face and can increase the risk of dysphagia. Here, we used a validated animal model feeding freely to test the effect of preterm birth, postnatal maturation and RLN lesion and their interactions on swallow safety. We also tested whether bolus size differed with lesion or birth status, and the relationship between bolus size and swallow safety. We found very little effect of lesion on swallow safety, and preterm infants did not experience more penetration or aspiration than term infants. However, term infants swallowed larger boluses than preterm infants, even after correcting for body size. Bolus size was the primary predictor of penetration or aspiration, with larger boluses being more likely to result in greater degrees of dysphagia irrespective of age or lesion status. These results highlight that penetration and aspiration are likely normal occurrences in infant feeding. Further, when comorbidities, such as RLN lesion or preterm birth are present, limiting bolus size may be an effective means to reduce incidences of penetration and aspiration.
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