Development of esophageal peristalsis in preterm and term neonates
Development of esophageal peristalsis in preterm and term neonates
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DOI：
10.1053/j.gastro.2007.03.042
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发表时间：
2007-05-01
期刊：
影响因子：
29.4
通讯作者：
Clouso, Ray E.
中科院分区：
文献类型：
--
作者：
Staiano, Annamaria;Boccia, Gabriella;Clouso, Ray E.
背景和目标：高分辨率测压显示了一系列3个连续的压力段，代表了儿童和成人的食管扩张。我们在早产儿中进行了高分辨率测压。和足月新生儿，以确定食管运动的个体发生与此段的架构。研究方法：16名早产儿（检查时胎龄32.9 +/- 2.6周）和14名足月新生儿（38.9 +/- 1.6周）使用9腔灌注导管进行测压，导管的记录侧孔间隔为1 cm。由一名对胎龄不知情的研究者评估吞咽的压力反应，以确定等压轮廓图上是否存在蠕动段。结果：在所有早产儿和足月新生儿中，第二段在>= 50%的吞咽中发育良好。相比之下，第一段出现在2例早产儿（12.5%）和8例足月儿（57.1%;与第二段相比，P <0.05）的吞咽中≥ 50%，第三段的发现相同（12.5%早产儿和57.1%足月儿; P <0.05）。在早产儿吞咽中，26% +/- 6%与足月新生儿吞咽中的55% +/- 9%（P = 0.01）存在完整的食管体节段性收缩序列。结论：食管中段（近端平滑肌区）的第二压力段在足月前发育良好。其他节段的存在显着改善，但在近一半的燕子仍然不完全。控制机制的横纹肌和平滑肌食管区域是不完全发达的新生儿，其结果可能参与婴儿反流病。
Background & Aims: High-resolution manometry demonstrates a chain of 3 sequential pressure segments that represent esophageal peristalsis in children and adults. We performed high-resolution manometry in preterm. and term neonates to determine the ontogenesis of esophageal motility with regard to this segmental architecture. Methods: Sixteen preterm (gestational age 32.9 +/- 2.6 weeks at examination) and 14 term neonates (38.9 +/- 1.6 weeks) underwent manometry with a 9-lumen perfused catheter having recording side holes spaced at 1-cm intervals. Pressure responses to swallows were evaluated for the presence of peristaltic segments on isobaric contour maps by an investigator who was blinded to gestational age. Results: The second segment was well developed in >= 50% of swallows in all preterm and term neonates. In contrast, the first segment was present in >= 50% of swallows in only 2 preterm neonates (12.5%) and 8 term neonates (57.1%; P < .05 for each compared with second segment) with identical findings for the third segment (12.5% preterm and 57.1% term neonates; P < .05 for each). Completed peristalses with intact segmental contraction sequences throughout the esophageal body were present in 26% +/- 6% of swallows in preterm neonates vs 55% +/- 9% in term neonates (P = .01). Conclusions: The second pressure segment in the midesophagus (proximal smooth-muscle region) is well developed before term. Presence of other segments significantly improves at term, but peristalsis remains incomplete in nearly half of swallows. Control mechanisms for both striated- and smooth-muscle esophageal regions are incompletely developed in neonates, the outcome of which could participate in infant reflux disease.