Pharyngeal Swallowing: Defining Pharyngeal and Upper Esophageal Sphincter Relationships in Human Neonates

Jadcherla, Sudarshan Rao; Gupta, Alankar; Stoner, Erin; Fernandez, Soledad; Shaker, Reza

doi:10.1016/j.jpeds.2007.04.042

« Previous Next »The Journal of Pediatrics
Volume 151, Issue 6 , Pages 597-603, December 2007

Pharyngeal Swallowing: Defining Pharyngeal and Upper Esophageal Sphincter Relationships in Human Neonates

Sudarshan Rao Jadcherla, MD, FRCPI, DCH
- From the Sections of Neonatology, Pediatric Gastroenterology, and Nutrition, Columbus Children’s Hospital and Department of Pediatrics, Ohio State University College of Medicine and Public Health, Columbus, OH
- Reprint requests: Sudarshan R. Jadcherla, MD, FRCPI, DCH, Section of Neonatology, Columbus Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205.
Alankar Gupta, MD, MS
- Section of Neonatology, Columbus Children’s Hospital, Columbus, OH
Erin Stoner, RN, BSN
- Section of Neonatology, Columbus Children’s Hospital, Columbus, OH
Soledad Fernandez, PhD
- Center for Biostatistics, Ohio State University College of Medicine and Public Health and Columbus Children’s Research Institute, Columbus, OH
Reza Shaker, MD
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Dysphagia Institute, Medical College of Wisconsin, Milwaukee, WI.

Received 22 August 2006; received in revised form 5 April 2007; accepted 19 April 2007. published online 24 August 2007.

Objective

To test the hypothesis that the sensorimotor characteristics of the reflexes evoked on stimulation with air and water infusions differ by studying the effect of pharyngeal stimulation on pharyngeal–upper esophageal sphincter (UES) interactions in healthy neonates.

Study design

Pharyngo-UES-esophageal manometry was recorded in 10 neonates at 39 ± 4 weeks postmenstrual age. Pharyngeal infusions (n = 155) of air (0.1 to 2.0 mL) and sterile water (0.1 to 0.5 mL) were given. Two types of reflexes were recognized: pharyngeal reflexive swallowing (PRS) and pharyngo-UES-contractile reflex (PUCR). Frequency occurrence, distribution of reflexes, threshold volume, response time, and stimulus–response relationship were evaluated.

Results

The reflex response rates were 30% for air and 76% for water (P < .001). PRS was more frequent than PUCR with air and water (P < .05), even though the stimulation thresholds and response latencies were similar. Graded volumes of water but not air resulted in an increased frequency of PRS (P < .01).

Conclusions

PRS is more frequent than PUCR, and the 2 reflexes have distinctive characteristics in air and water stimuli. Both PRS and PUCR have implications for the evaluation of swallowing in infants.

Abbreviations: EMG, Electromyography, GA, Gestational age, GEE, Generalized estimating equation, GER, Gastroesophageal reflux, PMA, Postmenstrual age, PRS, Pharyngeal reflexive swallowing, PUCR, Pharyngo–upper esophageal sphincter-contractile reflex, UES, Upper esophageal sphincter