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个重要功能。喂养困难加上与呼吸道有关的并发症，在婴儿的死亡率和发病率显着贡献。缺乏对发育中的婴儿在健康或疾病期间防止吸入的反射的生理学和病理生理学的适当理解是挑战管理策略的基本问题。我们的长期目标是为高危婴儿制定基于证据的安全喂养策略。目前的目标是确定正常的发展为基础，了解异常的感觉运动神经和肌肉控制的前肠运动和呼吸消化道防御机制在人类婴儿。迫切需要进行安全性保证机制研究，为（1）健康早产儿和（2）GERD和（3）神经系统疾病等疾病的喂养和气道安全性管理提供坚实的基础。目的1：研究正常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GERD与反流清除和声门闭合反射的关系，并与健康对照组进行比较。在目标3中，研究神经功能障碍对呼吸消化保护机制的影响，并与健康对照组进行比较。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，GERD和神经系统疾病的蠕动反射的感觉和运动元素。此外，我们将评估气道保护反射与同步超声。将使用方差分析、多元逻辑回归和学生t检验。新信息将为理解与蠕动反射和气道安全相关的感觉运动通路创造背景;从而为未来的临床护理或试验提供基础。

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.