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ABSTRACT: The aim of this study was to define quantitative measures for assessing the integration and maturation of suck and swallow rhythms in preterm infants as they relate to each other. Fourteen preterm infants (eight males, six females; gestational age range 26 to 32 weeks) with bronchopulmonary dysplasia (BPD) and an age-matched cohort of 20 infants (10 males, 10 females; gestational age range 26 to 33 weeks) without BPD were studied weekly from time of initiation of oral feeding using simultaneous recordings of nipple and pharyngeal pressure. The integration of suck and swallow rhythms was quantified by using the coefficient of variation (COV) of the suck-swallow dyad interval. Infants without BPD had a significant correlation between increasing postmenstrual age (PMA) and decreasing COV of the dyadic interval (increasing stabilization; r=0.45; p=0.008). In the non-BPD cohort 35 weeks or less PMA, the mean dyadic COV was 0.42 (SD 0.12) versus 0.34 (SD 0.09) in those more than 35 weeks PMA (p=0.039). In contrast, dyadic stability in infants with BPD was not correlated with PMA. Infants with BPD of more than 35 weeks PMA had less dyadic stability (0.45, SD 0.10) than did age-matched controls (p<0.001). Dyadic stability was also correlated with feeding efficiency in the non-BPD group (r=0.46;p=0.007) but not in the BPD cohort. Therefore, ontogeny of rhythmic suckle feeding can be described quantitatively in preterm infants, allowing comparison with at-risk populations. Infants with BPD do not follow predicted maturational patterns of suck-swallow rhythmic integration.
Developmental Medicine & Child Neurology 05/2003; 45(5):344-8. · 2.92 Impact Factor
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ABSTRACT: The objective of this study was to develop a method to use digital signal processing (DSP) technology to describe quantitatively and statistically swallow-associated sounds in preterm infants and to use this method to analyze changes as infants mature. Twelve recordings of accelerometric and physiological data on bottle-feeding preterm infants between 32 and 39 weeks' postmenstrual age (PMA) were analyzed. Cervical auscultation was performed using an accelerometer attached over the larynx. Acoustic data were recorded and graphically displayed using DSP software. Initial discrete sounds (IDSs) were identified and used to construct an average waveform from which a 'variance index' (VI) was calculated for each infant. The shape of the IDS waveforms became progressively more uniform with advancing PMA, as indicated by a significant inverse correlation between VI and PMA (r=0.739; p=0.006). DSP technology facilitated the development of a new method to quantitatively analyze feeding in preterm infants. This method provides an elegant tool to track maturation of infant feeding and assessing feeding readiness. This technique makes the interpretation of cervical auscultation data less subjective by replacing the verbal description of the sounds of feeding with quantitative numeric values. It is anticipated that this method can be automated to facilitate further the analysis of cervical accelerometry data.
Developmental Medicine & Child Neurology 10/2002; 44(9):587-92. · 2.92 Impact Factor
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ABSTRACT: To quantify parameters of rhythmic suckle feeding in healthy term infants and to assess developmental changes during the first month of life, we recorded pharyngeal and nipple pressure in 16 infants at 1 to 4 days of age and again at 1 month. Over the first month of life in term infants, sucks and swallows become more rapid and increasingly organized into runs. Suck rate increased from 55/minute in the immediate postnatal period to 70/minute by the end of the first month (p<0.001). The percentage of sucks in runs of > or =3 increased from 72.7% (SD 12.8) to 87.9% (SD 9.1; p=0.001). Average length of suck runs also increased over the first month. Swallow rate increased slightly by the end of the first month, from about 46 to 50/minute (p=0.019), as did percentage of swallows in runs (76.8%, SD 14.9 versus 54.6%, SD 19.2; p=0.002). Efficiency of feeding, as measured by volume of nutrient per suck (0.17, SD 0.08 versus 0.30, SD 0.11 cc/suck; p=0.008) and per swallow (0.23, SD 0.11 versus 0.44, SD 0.19 cc/swallow; p=0.002), almost doubled over the first month. The rhythmic stability of swallow-swallow, suck-suck, and suck-swallow dyadic interval, quantified using the coefficient of variation of the interval, was similar at the two age points, indicating that rhythmic stability of suck and swallow, individually and interactively, appears to be established by term. Percentage of sucks and swallows in 1:1 ratios (dyads), decreased from 78.8% (SD 20.1) shortly after birth to 57.5% (SD 25.8) at 1 month of age (p=0.002), demonstrating that the predominant 1:1 ratio of suck to swallow is more variable at 1 month, with the addition of ratios of 2:1, 3:1, and so on, and suggesting that infants gain the ability to adjust feeding patterns to improve efficiency. Knowledge of normal development in term infants provides a gold standard against which rhythmic patterns in preterm and other high-risk infants can be measured, and may allow earlier identification of infants at risk of neurodevelopmental delay and feeding disorders.
Developmental Medicine & Child Neurology 02/2002; 44(1):34-9. · 2.92 Impact Factor
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ABSTRACT: Twenty healthy preterm infants (gestational age 26 to 33 weeks, postmenstrual age [PMA] 32.1 to 39.6 weeks, postnatal age [PNA] 2.0 to 11.6 weeks) were studied weekly from initiation of bottle feeding until discharge, with simultaneous digital recordings of pharyngeal and nipple (teat) pressure and nasal thermistor and thoracic strain gauge readings. The percentage of sucks aggregated into‘runs’(defined as ≥ 3 sucks with ≤ 2 seconds between suck peaks) increased over time and correlated significantly with PMA (r=0.601, p<0.001). The length of the sucking-runs also correlated significantly with PMA (r=0.613, p<0.001). The stability of sucking rhythm, defined as a function of the mean/SD of the suck interval, was also directly correlated with increasing PMA (r=0.503, p=0.002), as was increasing suck rate (r=0.379, p<0.03). None of these measures was correlated with PNA. Similarly, increasing PMA, but not PNA, correlated with a higher percentage of swallows in runs (r=0.364, p<0.03). Stability of swallow rhythm did not change significantly from 32 to 40 weeks’PMA. In low-risk preterm infants, increasing PMA is correlated with a faster and more stable sucking rhythm and with increasing organization into longer suck and swallow runs. Stable swallow rhythm appears to be established earlier than suck rhythm. The fact that PMA is a better predictor than PNA of these patterns lends support to the concept that these patterns are innate rather than learned behaviors. Quantitative assessment of the stability of suck and swallow rhythms in preterm infants may allow prediction of subsequent feeding dysfunction as well as more general underlying neurological impairment. Knowledge of the normal ontogeny of the rhythms of suck and swallow may also enable us to differentiate immature (but normal) feeding patterns in preterm infants from dysmature (abnormal) patterns, allowing more appropriate intervention measures.
Developmental Medicine & Child Neurology 12/2000; 43(1):22 - 27. · 2.92 Impact Factor
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ABSTRACT: The authors recorded the sound signals during suckle feeding of six normal infants within the first two postnatal days. The sounds were recorded onto a cassette tape-recorder from a small microphone attached to the infant's neck, then displayed on an oscilloscope and analysed by digital signal processing techniques. These displays demonstrated acoustic patterns and temporal relationships which are not otherwise audible. The method and findings are described in detail, and the method should be useful in the clinical investigation of feeding and swallowing problems associated with more subtle neurological impairment and preterm birth.RÉSUMÉAuscultation cervicale de I'allaitement chez le nouveau-néLes auteurs ont enregistré les signaux sonores de six nouveaux-nés normaux durant l'allaitement, les deux premiers jours post-nataux. Les sons ont été enregistrés sur cassette magnétique à partir d'un petit microphone attaché au cou du nourrisson, puis transmis sur oscilloscope et analysés par les procédés habituels de traitement de signal. La transcription révélait des groupements acoustiques et des relations temporelles non directement audibles. La méthode et les résultats sont décrits en détail et la méthode peut être utile dans l'investigation clinique de l'allaitement et des problèmes de déglutition associés à un trouble neurologique mineur ou à une naissance prématurée.ZUSAMMENFASSUNGCervicale Auskultation whrend des Trinkens bei NeugeborenenDie Autoren haben die Gerusche beim Trinken bei sechs gesunden Neugeborenen in den ersten zwei Tagen nach der Geburt aufgenommen. Die Gerusche wurden über ein kleines Mikrophon, das am Hals des Kindes befestigt war, mit einem Kassettenrekorder aufgenommen, auf einen Oszillographen übertragen und mit Hilfe einer digitalen Signalverarbeitungstechnik analysiert. Diese Aufschlüsselungen zeigten akustische Muster und zeitliche Zusammenhnge, die sonst nicht wahrnehmbar sind. Methode und Befunde werden genau beschrieben. Die Methode sollte bei der klinischen Untersuchung von Fütterungs- und Schluckproblemen in Verbindung mit subtilen neurologischen Störungen und Frühgeburt eine Hilfe sein.RESUMENAuscultación cervical en la succión de alimento en los recién nacidosLos autores registraron las señales acústicas durante la succión de alimento en seis lactantes normales en el curso de los dias postnatales. Los sonidos se registraron en un cassette a partir de un pequeño micrófono fijado al cuello del niño y luego observados en un osciloscopio y analizados por técnicas de procesamiento de señal digital. De esta forma se demostraron patrones acústicos y relaciones temporales que de otra forma no son audibles. Se describen con detalle el método y los hallazgos. El método seria útil en la investigación clinica de la deglució y de los problemas de ella y de la alimentacion, asociados con alteraciones sutiles neurológicas y con el nacimiento pretérmino.
Developmental Medicine & Child Neurology 08/1990; 32(9):760 - 768. · 2.92 Impact Factor
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ABSTRACT: This gross anatomical illustration and summary are pertinent to the clinical evaluation of the pharynx. The principal concerns
in this article are with the pharynx in reference position, although the mechanisms and directions of its motions during swallowing
and speech are noted.
For further description and understanding of the foodway anatomy, the information in this article should be supplemented with
material from such textbooks as those noted in the bibliography.
Dysphagia 04/1986; 1(1):23-33. · 1.39 Impact Factor
