Pathophysiology of Aerodigestive Reflexes in Infants

描述（由申请人提供）：独立喂养和呼吸技能是人类婴儿生存的两项重要功能。婴儿喂养困难加上气道相关并发症是导致婴儿死亡率和发病率的重要原因。缺乏对发育中的婴儿在健康或疾病期间防止误吸的生理和病理生理学的正确理解是挑战管理策略的一个根本问题。我们的长期目标是为处于危险中的婴儿制定基于证据的安全喂养策略。当前的目标是定义正常发育，作为理解人类婴儿前肠运动的感觉-运动神经和肌肉控制以及空气消化道防御机制异常的基础。迫切需要进行安全机制研究，这将为(1)健康早产儿以及(2)胃食管反流和(3)神经系统疾病等情况下的喂养和气道安全管理提供坚实的基础。目的1：研究健康早产儿在睡眠和清醒状态下食管刺激引起的蠕动反射。在目标2中，研究了反流清除和声门关闭与胃食管反流反射的关系，并与健康对照进行了比较。目的3：研究神经功能障碍对空气消化保护机制的影响，并与健康对照进行比较。使用安全包装，尖端技术和微测压系统和新型咽-食管测压导管，同步和综合呼吸测量，我们将评估早产儿，胃食管反流和神经系统疾病的蠕动反射的感觉和运动因素。此外，我们将通过并发超声评估气道保护反射。本研究将采用方差分析、多元逻辑回归及学生t检验。新的信息将为理解与蠕动反射和气道安全有关的感觉运动通路创造一个背景；从而为今后的临床护理或试验提供依据。

DESCRIPTION (provided by applicant): Independent feeding and breathing skills are the two important functions for survival in human infants. Feeding difficulties coupled with airway-related complications in infants contribute significantly to infant mortality and morbidity. Lack of a proper understanding of the physiology and pathophysiology of reflexes protective against aspiration during health or disease in developing infants is a fundamental problem that challenges management strategies. Our long-term goal is to develop evidence-based safe feeding strategies in infants at-risk. The current objective is to define the normal development as a basis for understanding abnormality of the sensory-motor neural and muscular control of foregut motility and aerodigestive tract defense mechanisms in human infants. There is a critical need for safety-ensured mechanistic studies that will provide a solid foundation for the management of feeding and airway safety in (1) healthy premature infants and in conditions such as (2) GERD and (3) neurological disease. In aim 1, peristaltic reflexes induced by esophageal stimulation in preterm healthy infants in sleep and awake states are investigated. In aim 2, the relationship of GERD on reflux clearance- and glottal closure- reflexes and comparison with healthy controls are investigated. In aim 3, the effects of neurological malfunction on aerodigestive protective mechanisms and comparison with healthy controls are investigated. Using safety packed, cutting-edge techniques and micromanometry system and novel pharyngo-esophageal manometry catheters, synchronized and integrated respiratory measurements, we will evaluate the sensory and motor elements of the peristaltic reflexes in premature infants, GERD, and neurological illness. In addition, we will evaluate airway protective reflexes with concurrent ultrasound. ANOVA, multiple logistic regression and student's t- test will be used. The new information will create a context for understanding sensory-motor-pathways involved with peristaltic reflexes and airway safety; thus providing a basis for future clinical care or trials.