MECHANICALLY EVOKED REFLEXES & FUNCTIONAL OROMOTOR SKILLS IN PRE TERM

在早产儿中，导致成功口腔喂养的神经生理发育序列仍然描述得很差，这主要是因为没有涉及口腔运动功能的感觉神经通路的客观测量。本研究的长期目标是使用一种新的方法来描述早产儿口周感觉运动功能的成熟，这可能会应用于评估早产儿的神经发育完整性，以及开发特定的干预措施。我们建议使用机械诱发的口周反射反应结合吸吮的功能评估来检验以下假设：1)婴儿在非营养性吸吮过程中发展的神经生理口周反射和口腔运动反应的有组织的本体论序列，取决于概念后的成熟。2)口周反射发育模式的延迟或异常会继发于异常的口周/口内刺激和/或缺乏正常刺激。3)发育中的新生儿中枢神经系统损伤会导致口周反射个体发育迟缓或异常。为了验证这些假说，我们将前瞻性地对三组早产儿(孕28周)进行肌电运动测量：1)健康的早产儿；2)经历长时间插管的早产儿；3)有III和IV级脑室出血的早产儿。通过测量吸吮的开始时间、口腔内的吸气压力和与吸吮相协调的呼吸周期来获得吸吮的功能评估。使用所提出的方法对婴儿早期的口部运动反射进行的初步研究表明，潜伏期和特异度发生了非常显着的变化，这与成熟度有关。然而，早产儿的口周神经生理功能此前并未使用这些技术进行测量。这些拟议的研究将首次提供有关这一关键功能能力发展的客观、可量化的信息。此外，确定感觉运动反射是神经发育评估的一种新方法，并可能最终形成设计特定干预措施的基础。

The neurophysiologic developmental sequence leading to successful oral feeding remains poorly delineated in the preterm infant largely because there are no objective measures of the sensorineural pathways involved in oromotor function. The long term goal of this research is to describe the maturation of perioral sensorimotor function of the preterm infant using a new methodology, which has the potential for application in the assessment of neurodevelopmental integrity of the preterm infant, as well as for the development of specific interventions. We propose to use the mechanically evoked perioral reflex responses combined with functional assessment of sucking to test the following hypotheses: 1) An organized ontologic sequence of neurophysiologic perioral reflexes and oromotor responses developed in the infant during nonnutritive sucking, dependent upon post conceptual maturation. 2) Delay or aberration in the developmental pattern of perioral reflexes will occur secondary to abnormal external perioral/intraoral stimuli and/or lack of normal stimuli. 3) Injury to the central nervous system in the developing neonate will result in delay or abnormality of the ontogeny of the perioral reflexes. To test these hypotheses electromyographic oromotor measurements will be prospectively obtained in three groups of preterm infants (28 weeks gestation): 1) healthy preterm infants; 2) preterm infants who have experienced prolonged intubation and 3) preterm infants with grades III and IV intraventricular hemorrhage. Functional assessment of sucking will be obtained by measuring the onset of suck, the suck pressure inside the oral cavity and the respiratory cycle in coordination with the suck. Preliminary studies of the oromotor reflexes in early infancy using the proposed methodology indicate highly significant changes in latency and specificity which correlate with maturation. However, perioral neurophysiologic function has not been measured previously using these techniques in the preterm infant. These proposed studies will provide objective, quantifiable information for the first time concerning the development of this critical functional ability. Furthermore, determining sensorimotor reflexes is a novel approach to neurodevelopmental assessment, and may ultimately form the basis for designing specific interventions.