The impact of sensory intervention on motor output and feeding performance in term and preterm infants

婴儿喂养是一种复杂的行为，既需要获得乳汁的能力，也需要运输和排泄的能力

Infant feeding is a complex behavior that requires the ability to both acquire milk, as well as transport and swallow it. Preterm infants often exhibit a decreased ability to generate suction pressure to acquire milk, and experience challenges transporting and swallowing milk. Understanding the mechanisms behind these challenges is difficult due to the complexity of infant feeding as well as the fragile nature of preterm infants. Feeding is controlled by multiple cranial nerves and over 25 muscles, yet we know little of how those muscles function due to the ethical and practical restrictions of acquiring data on human infants. Clinicians cannot control for the degree of prematurity in their patients, cannot measure muscle function accurately or precisely, and are limited in the temporal resolution of their data, due to radiation from videofluoroscopic swallowing studies. The objective of this proposal is to use a validated animal model to acquire controlled, high resolution data to study how term and preterm infants respond to interventions to improve feeding performance during feeding. This research will combine bi-planar (3D) high speed (100 fps) videofluoroscopy with chronic indwelling fine-wire electromyography to measure how muscles drive the kinematics, swallow safety, and fluid dynamics of term and preterm infant feeding. The central hypothesis is that term infants will show higher levels of pressure generation and ability to transport viscous fluids, but that the plastic neural system of preterm infants will enable them to exhibit a greater response to increases in pressure generation requirements and increases in viscosity. First, I will measure how the musculoskeletal system responds to changes in pressure generation requirements to acquire food in term and preterm infant pigs (SA1-K99), and then measure the neuromotor response to changes in viscosity in term and preterm infant pigs (SA2-K99). Following these, I will measure neuromotor function of term and preterm infants when feeding on a biomimetic nipple, compared to those currently available commercially (SA3-R00).This research will provide insight into the mechanisms driving feeding performance in infants and provide a foundation for developing interventions based off physiologic, rather than qualitative, indications of poor performance for patients with dysphagia. This is significant because it represents an important advance in the basic understanding of the mechanisms of infant feeding, and mechanisms of failure. As such these results will be the foundation for evidence-based interventions for neonate dysphagia. This project will directly advance my career goals to establish a federally funded research program grounded in understanding normal and pathophysiologic sensorimotor integration. NEOMED is an excellent environment for me to develop this research program, as there are an array of faculty within the department that conduct cutting edge research on musculoskeletal function, in addition to my research mentor, whom is an expert in the field of infant dysphagia.