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: 10401808
• 负责人: Rebecca Z German
• 金额: $ 57.01万
• 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/10401808
• 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; 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; effectiveness evaluation; effectiveness testing; 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，经常会受到影响， 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 外部口腔感觉刺激诱导有节奏的吮吸，且这种刺激保持 作为康复策略的潜力。然而，我们对这些影响的理解 对呼吸消化功能的干预是有限的，因为人类早产儿是一个 脆弱的研究人群，实验操作的限制。我们也不 知道早产的程度和随后的神经成熟的作用， 早产儿的大脑在决定口腔刺激的有效性方面起着作用， 便于喂食。因此，将这些有希望的结果转化为有效的 促进早产儿持续口服喂养的干预措施不足。使用 早产儿的动物模型，我们建议测试如何以营养刺激的形式 有节奏的牛奶输送，作为改善呼吸消化功能的干预措施。我们 将测试两个因素，可能决定这种干预的成功： 干预和早产程度。我们将采取干预措施， （早期婴儿期）或更长时间（断奶前的整个婴儿期）。每个处理中 根据出生时的呼吸状态，将有两个独立的年龄组：（1） 能够独立呼吸或（2）需要气泡CPAP通气支持。我们将 将这些婴儿与仅接受非营养性刺激的奶瓶喂养的个体进行比较 和那些只吃奶瓶的人。我们已经证明并验证了该模型， 研究早产儿的呼吸消化功能，以及提出的干预措施。的 实验方法将包括高速双平面视频荧光成像，肌电图 和呼吸，我们将从中提取评估气道保护的结果变量， 呼吸、吸吮和吞咽的节律性，以及这些之间的协调 行为。这项工作的意义是确定如何，在什么年龄，口腔 刺激改变了早产儿喂养的功能和潜在生理学， 呼吸协调通过测试婴儿神经运动成熟与 以及刺激治疗的有效性，这项工作将为 随后开发了新的神经和生理治疗干预措施 影响所有婴儿喂养的并发症。