Pharyngeal Stimulus-induced Reflexes Are Impaired in Infants with Perinatal Asphyxia: Does Maturation Modify?

Overview

Journal Neurogastroenterol Motil

Specialties Gastroenterology
Neurology

Date 2017 Mar 4

PMID 28256028

Citations 3

Authors

P S Jensen

I K Gulati

T R Shubert

S Sitaram

M Sivalingam

K A Hasenstab

M A El-Mahdy

S R Jadcherla

Affiliations

Soon will be listed here.

Abstract

Background: Development of pharyngo-esophageal protective reflexes among infants with hypoxic ischemic encephalopathy (HIE) is unclear. Our aim was to distinguish these reflexes from controls and examine the maturational changes in HIE infants.

Methods: We evaluated 14 HIE infants (seven males) at 41.4±0.6 (HIE Time-1) and 46.5±0.6 (HIE Time-2) weeks postmenstrual age (PMA). Seven controls (three males) were evaluated at 43.5±1.3 weeks PMA. Graded pharyngeal stimulation with liquids (0.1, 0.3, 0.5 mL in triplicate) concurrent with high-resolution manometry was used to analyze sensory-motor components of pharyngeal reflexive swallowing (PRS), upper esophageal sphincter (UES), contractile reflex (PUCR), and esophageal body characteristics. Linear mixed and generalized estimating equation models were used for comparison among groups.

Key Results: Compared to controls, HIE infants (Time-1 and Time-2) exhibited decreased number of pharyngeal peaks and latency to terminal swallow. HIE Time-1 infants showed increased UES resting tone and distal latency, compared to controls and HIE Time-2. Contractile vigor was increasingly abnormal during maturation, compared to healthy controls. Threshold volumes and frequency distribution of primary responses (PRS: PUCR: None) were not significant among all groups.

Conclusions & Inferences: Compared to controls, HIE infants display significant hypertonicity of skeletal muscle components, impairment of pharyngeal provocation-induced reflexes and smooth muscle contractile vigor, reflecting poor propagation with maturation. These mechanisms may be responsible for inadequate clearance of secretions, ascending refluxate, and oropharyngeal bolus in HIE infants.

Citing Articles

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Jenkins D, Moss H, Adams L, Hunt S, Dancy M, Huffman S J Pediatr. 2023; 262:113563.

PMID: 37329979 PMC: 11000235. DOI: 10.1016/j.jpeds.2023.113563.

Filling the Gaps for Feeding Difficulties in Neonates With Hypoxic-Ischemic Encephalopathy.

Arora I, Bhandekar H, Lakra A, Lakra M, Khadse S Cureus. 2022; 14(8):e28564.

PMID: 36185935 PMC: 9521296. DOI: 10.7759/cureus.28564.

Defining pharyngeal contractile integral during high-resolution manometry in neonates: a neuromotor marker of pharyngeal vigor.

Jadcherla S, Prabhakar V, Hasenstab K, Nawaz S, Das J, Kern M Pediatr Res. 2018; 84(3):341-347.

PMID: 29976974 PMC: 6258262. DOI: 10.1038/s41390-018-0097-6.

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