Pathophysiology of Aerodigestive Reflexes in Infants

描述(申请人提供)：独立进食和呼吸技能是人类婴儿生存的两个重要功能。婴儿喂养困难加上与呼吸道有关的并发症，极大地增加了婴儿死亡率和发病率。缺乏对婴幼儿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正确理解，是一个挑战管理策略的根本问题。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。目前的目标是将正常发育定义为了解人类婴儿感觉-运动神经和肌肉对前肠运动的控制和呼吸消化道防御机制的异常的基础。迫切需要确保安全的机械性研究，为(1)健康早产儿和(2)胃肠道反流病(GERD)和(3)神经系统疾病等情况下的喂养和呼吸道安全管理提供坚实的基础。目的1研究早产健康婴儿在睡眠和清醒状态下食道刺激诱发的蠕动反射。在目的2中，研究GERD对返流清除和声门关闭反射的关系，并与健康对照组进行比较。目的3研究神经功能障碍对空气消化保护机制的影响，并与健康对照组进行比较。使用安全包装、尖端技术和显微测压系统以及新型咽-食道测压导管、同步和集成呼吸测量，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，我们还将使用同步超声评估呼吸道保护性反射。将使用方差分析、多元Logistic回归和学生t检验。新的信息将为理解与蠕动反射和呼吸道安全有关的感觉-运动路径创造背景；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.