VIDEOFLUOROSCOPY OF PRETERM INFANT SWALLOWING

描述(由申请人提供)：在过去的十年中，出生在胎龄33周以下的早产儿的存活率大幅增加，但这些婴儿在开始口服喂养时可能会表现出吞咽障碍或吞咽困难。其中一半在36周后会继续表现出吞咽困难，那时应该可以毫无困难地完成足量的口腔喂养。吞咽困难有严重的临床后果，包括营养不良、生长迟缓，以及与将液体吸入呼吸道相关的肺炎风险。早产儿吞咽稀薄液体时吞咽困难更为明显。由于中枢神经系统的不成熟，早产儿可能更难检测到稀薄液体的流动特性。受试者为吞咽困难的早产儿，出生时间小于33周，最初由医生转介到36至42周的儿童医院进行VFSS评估。本研究的具体目的是验证3种假设，即在视频透视下的吞咽研究中，早产儿吞咽稀液或浓液时的吞咽和呼吸道保护。在36-42周的VFSS中检验了两个假设：(1)吞咽时更有可能发生液体吸入，此时吞咽动作(例如，舌根密封呼吸道)和液体团注运动之间的协调性较差，(2)吞咽稀液时，吞咽运动的时机与液体团注传输的协调性较差。第三个假设是在随访三个月的VFSS中检验的，这些婴儿在36到42周的评估中表现出液体吸入，并被处方了用于家庭喂养的增稠配方：(3)与最初的VFSS相比，在三个月时，吞咽运动和团注之间的协调性将得到改善，并且没有液体吸入。研究假设通过对婴儿吞咽过程中硫酸钡粘度的实验操作、对记录的燕子图像的运动学分析，以及在VFSS评估完成后常规喂养期间的吸吮、吞咽和呼吸的非放射记录来验证。

DESCRIPTION (provided by applicant): The survival of preterm infants born less than 33 weeks gestational age (GA) has increased dramatically over the past decade, but these infants are likely to exhibit impaired swallowing, or dysphagia, when they begin oral feeding. Half will continue to exhibit dysphagia after 36 weeks, when full volume oral feedings should be achieved without difficulty. Dysphagia has significant clinical consequences, including malnutrition growth retardation, and risk of pneumonia associated with taking fluid into the airway. Dysphagia among preterm infants is more pronounced when swallowing thin fluids. Due to their CNS immaturity, preterm infants may have greater difficulty detecting the flow properties of thin fluids. Subjects are dysphagic preterm infants, born less than 33 weeks GA, initially referred by physician between 36 to 42 weeks to Children's Hospital for a VFSS evaluation. The specific aims are to test 3 hypotheses concerning swallowing and airway protection as preterm infants swallow thin or thick fluids during videofluoroscopic swallow study. Two hypotheses are tested at a 36 to 42 week VFSS: (1) aspiration of fluid will be more likely to occur during swallows in which there is poor coordination between a swallow gesture (e.g., the tongue base sealing the airway) and fluid bolus movement, (2) Timing of swallow movements will be less well coordinated with fluid bolus transit when swallowing thin fluids compared to thick fluids. The third hypothesis is tested at a followup three month VFSS for infants who exhibited fluid aspiration during the 36 to 42 week evaluation, and who were prescribed a thickened formula for home feedings: (3) At three months, compared to the initial VFSS, there will be improved coordination between swallow movements and bolus transit and no fluid aspiration. The study hypotheses are tested by experimental manipulation of barium sulfate viscosity during infant swallowing, kinematic analysis of recorded swallow images, and non-radiologic recordings of sucking, swallowing, and breathing during a regular feeding after the VFSS evaluation is completed.