Pharyngeal biorhythms during oral milk challenge in high-risk infants: Do they predict chronic tube feeding?
Pharyngeal biorhythms during oral milk challenge in high-risk infants: Do they predict chronic tube feeding?
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高危婴儿口服牛奶挑战期间的咽生物节律：他们是否预测慢性管喂养？
DOI：
10.1111/nmo.14492
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发表时间：
2023-02
影响因子：
3.5
通讯作者：
Jadcherla, Sudarshan R.
中科院分区：
文献类型：
--
作者：
Hasenstab, Kathryn A.;Prabhakar, Varsha;Helmick, Roseanna;Yildiz, Vedat;Jadcherla, Sudarshan R.
关键词：
进食困难在高危新生儿重症监护病房(NICU)婴儿中很常见；机制尚不清楚。婴儿床旁咽-食道运动测试用于评估连续吞咽生理，以及跨系统与心肺节律的相互作用。目的是：(1)确定在口服乳汁挑战(OMC)期间是否存在明显的咽部节律，以及(2)建立高危婴儿慢性管饲风险预测模型。有症状的新生儿重症监护室新生儿(N=0.56，29.7 ± 3.7 周)在月经后40.9 ± 2.5 周行咽-食道测压。使用咽部收缩节律数据(单独的燕子和爆发中的燕子)进行探索性集群数据分析(围绕k-medoid进行划分)以识别患者组。随后，(A)使用线性混合模型比较患者组之间咽部-食道、心肺和进食方式的特征，以及(B)使用线性回归建立慢性管饲预测模型。三个不同的患者组被确定为有效性分数为0.6，并被命名为稀疏(高频率的单独吞咽)、中等或健壮(突发性高吞咽率)。健康组婴儿的咽部和食道变异性较小，吞咽呼吸暂停、咽部活动和食道活动较多(均p <； 0.05)，但心率减慢的频率较少(p <； 0.05)，临床结果得到改善(牛奶转移率，p <； 0.001，出院时独立口服喂养，p <； 0.03)。慢性管饲风险=−11.37 + (0.22 × PMA) + (−0.73 × bronchopulmonary异型增生) + (1.46 × 中间组) + (2.57 × 稀疏组)。强健的咽音节律可能是独立进食的理想神经感觉运动生物标志物。脑神经介导的涉及前肠、呼吸道和心律的兴奋和抑制成分的不同成熟区分了吞咽和心肺适应的生理学和病理生理学基础。对高危新生儿在奶瓶喂养挑战期间咽部吞咽节律的探索性分析揭示了三个不同的患者组：(A)稀疏-主要是孤立的燕子，(B)中等--孤立的燕子和较短的猝发，(C)健壮的-主要是较长的猝发。患者组和成年后年龄预测独立口腔喂养的成功。
Eating difficulties are common in high‐risk neonatal intensive care unit (NICU) infants; mechanisms remain unclear. Crib‐side pharyngo‐esophageal motility testing is utilized to assess contiguous swallowing physiology, and cross‐system interplay with cardio‐respiratory rhythms. Aims were to: (1) identify whether distinct pharyngeal rhythms exist during oral milk challenge (OMC), and (2) develop a chronic tube feeding risk prediction model in high‐risk infants. Symptomatic NICU infants (N = 56, 29.7 ± 3.7 weeks birth gestation) underwent pharyngo‐esophageal manometry with OMC at 40.9 ± 2.5 weeks postmenstrual age (PMA). Exploratory cluster data analysis (partitioning around k‐medoids) was performed to identify patient groups using pharyngeal contractile rhythm data (solitary swallows and swallows within bursts). Subsequently, (a) pharyngeal‐esophageal, cardio‐respiratory, and eating method characteristics were compared among patient groups using linear mixed models, and (b) chronic tube feeding prediction model was created using linear regression. Three distinct patient groups were identified with validity score of 0.6, and termed sparse (high frequency of solitary swallows), intermediate, or robust (high swallow rate within bursts). Robust group infants had: lesser pharyngeal and esophageal variability, greater deglutition apnea, pharyngeal activity, and esophageal activity (all p < 0.05), but less frequent heart rate decreases (p < 0.05) with improved clinical outcomes (milk transfer rate, p < 0.001, and independent oral feeding at discharge, p < 0.03). Chronic tube feeding risk = −11.37 + (0.22 × PMA) + (−0.73 × bronchopulmonary dysplasia) + (1.46 × intermediate group) + (2.57 × sparse group). Robust pharyngeal rhythm may be an ideal neurosensorimotor biomarker of independent oral feeding. Differential maturation of cranial nerve‐mediated excitatory and inhibitory components involving foregut, airway, and cardiac rhythms distinguishes the physiologic and pathophysiologic basis of swallowing and cardio‐respiratory adaptation. Exploratory analysis of pharyngeal swallowing rhythms during bottle feeding challenge in high‐risk neonates revealed three distinct patient groups: (A) Sparse—primarily solitary swallows, (B) Intermediate—solitary swallows and shorter bursts, and (C) Robust—primarily longer bursts. Patient group and postmaturational age predict independent oral feeding success.
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影响因子：
2.6
作者：
Hasenstab KA;Sitaram S;Lang IM;Shaker R;Jadcherla SR
通讯作者：
Jadcherla SR
影响因子：
5.1
作者：
Jadcherla, Sudarshan Rao;Gupta, Alankar;Shaker, Reza
通讯作者：
Shaker, Reza
DOI：
10.1152/ajpgi.00307.2015
发表时间：
2016-06-01
影响因子：
4.5
作者：
Jadcherla, Sudarshan R.;Hasenstab, Kathryn A.;Shaker, Reza
通讯作者：
Shaker, Reza
DOI：
10.1097/mpg.0b013e3181752ce7
发表时间：
2009-02-01
影响因子：
2.9
作者：
Jadcherla, Sudarshan R.;Stoner, Erin;Linscheld, Thomas
通讯作者：
Linscheld, Thomas
影响因子：
5.1
作者：
Collins, Carissa R.;Hasenstab, Kathryn A.;Jadcherla, Sudarshan R.
通讯作者：
Jadcherla, Sudarshan R.