The effect of sensory intervention on swallowing and respiration through neurological maturation in preterm infants

感觉干预通过神经成熟对早产儿吞咽和呼吸的影响

• 批准号: 9765480
• 负责人: Rebecca Z German
• 金额: $ 62.45万
• 依托单位: NORTHEAST OHIO MEDICAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9765480
• 关键词: Affect; Aftercare; Age; Animal Model; Aspirate substance; Behavior; Behavior Therapy; Birth; Bottle feeding; Brain; Breathing; Continuous Positive Airway Pressure; Deglutition; Deglutition Disorders; Development; Effectiveness; Electromyography; Family suidae; Gestational Age; Goals; Health; Human; Individual; Infant; Ingestion; Intervention; Long-Term Effects; Methods; Milk; Mission; Nervous system structure; Neurologic; Oral; Oropharyngeal; Outcome; Outcome Measure; Patients; Periodicity; Physiological; Physiology; Play; Population Research; Premature Infant; Research; Respiration; Role; Safety; Sensory; Speed; Stimulus; Study models; System; Testing; Therapeutic Intervention; Translations; United States National Institutes of Health; Weaning; Work; age group; base; effective intervention; feeding; improved; infancy; novel therapeutic intervention; nutrition; oral sensory; premature; rehabilitation strategy; respiratory; sensorimotor control mechanism; sensory stimulus; success; sucking; treatment duration

Sucking, swallowing, and their coordination with breathing, are often compromised in preterm infants, yet are critical to their long-term health outcomes. Current work suggests that external oral sensory stimuli induce rhythmic sucking, and that such stimuli hold potential as rehabilitation strategies. However, our understanding of the impact of these interventions on aerodigestive function is limited because human preterm infants are a fragile research population, with restrictions on experimental manipulations. We also do not know the role that the degree of prematurity and the subsequent neurological maturation of the preterm infant brain plays in determining the effectiveness of oral stimulation in facilitating feeding. Thus, the translation of these promising results into effective interventions for promoting sustained oral feeding in preterm infants is inadequate. Using an animal model of preterm infants, we propose to test how nutritive stimulation, in the form of rhythmic milk delivery, functions as an intervention for improving aerodigestive function. We will test two factors that may determine the success of this intervention: the duration of intervention and degree of prematurity. We will apply the intervention for either a short term (early infancy) or for a longer term (entire infancy prior to weaning). Within each treatment duration, there will be two independent age groups, defined by respiratory status at birth: (1) capable of independent respiration or (2) requiring bubble CPAP ventilation support. We will compare these infants to bottle fed individuals who receive only non-nutritive stimulation and to individuals who are only bottle fed. We have proven and validated this model for studying aerodigestive function in preterm infants, as well as the interventions proposed. The experimental methods will include high-speed biplanar videoflurography, electromyography and respiration, from which we will extract outcome variables assessing airway protection, rhythmicity of respiration, sucking and swallowing, and coordination amongst these behaviors. The significance of this work is the determination of how, and at what age, oral stimuli change the function and the underlying physiology of preterm infant feeding- respiration coordination. By testing the relationship between infant neuromotor maturation and the effectiveness of stimulation-based treatment, this work will provide a basis for the subsequent development of new therapeutic interventions for neurological and physiological complications which affect feeding in all infants.

吮吸，吞咽，以及它们与呼吸的协调，通常在 早产儿，但对他们的长期健康结果至关重要。目前的研究表明 外部口腔感官刺激引起有节奏的吸吮，并且这种刺激保持 作为康复战略的潜力。然而，我们对这些影响的理解 对空气消化功能的干预有限，因为人类早产儿是 脆弱的研究群体，对实验操作有限制。我们也不会 了解早产程度和随后的神经成熟度的作用 早产儿大脑在决定早产儿口腔刺激效果中的作用 方便喂食。因此，将这些有希望的成果转化为有效的 促进早产儿持续口服喂养的干预措施是不够的。使用 对于早产儿的动物模型，我们建议测试营养刺激如何，以 有节奏的送奶，起到改善空气消化功能的干预作用。我们 将检验可能决定这一干预成功的两个因素： 干预措施和早产程度。我们将在短期内实施干预 (早期婴儿期)或较长期(断奶前的整个婴儿期)。在每种治疗中 持续时间，将有两个独立的年龄组，由出生时的呼吸状况定义：(1) 能够自主呼吸或(2)需要气泡式CPAP支持。我们会 将这些婴儿与只接受非营养刺激的奶瓶喂养的婴儿进行比较 以及那些只接受奶瓶喂养的人。我们已经证明并验证了此模型 研究早产儿的空气消化功能，并提出干预措施。这个 实验方法将包括高速双平面视频荧光成像、肌电成像 和呼吸，我们将从中提取评估呼吸道保护的结果变量， 呼吸、吮吸和吞咽的节律性，以及它们之间的协调 行为。这项工作的意义在于确定如何以及在什么年龄进行口腔治疗 刺激改变了早产儿喂养的功能和基本生理- 呼吸协调。通过检测婴儿神经运动成熟度与 而刺激型治疗的有效性，这项工作将为今后的研究提供依据 神经和生理学新的治疗干预措施的后续发展 影响所有婴儿喂养的并发症。