Innovative Methods to Examine Swallowing in Premature Infants

Newswise — Researchers at Columbus Children's Research Institute on the campus of Columbus Children's Hospital have developed novel methods to test the nerve-muscle function using micromanometric catheters (which record pressures generated by muscles in the bowel wall) to enable them to study the swallowing mechanisms in premature infants. Details of their study " the first of its kind " were published in the July issue of the Journal of Pediatrics and supported by a grant from the National Institute of Digestive, Diabetes, and Kidney Diseases (NIDDK). The development of these new methods will enable researchers to conduct advanced studies on infant feeding problems. "Feeding problems are a big issue in the neonatal intensive care unit (NICU)," said Sudarshan Jadcherla, M.D., attending neonatologist, associate professor of pediatrics department of neonatology. "Any infant who doesn't eat is said to have a 'feeding problem.' The trouble is, we don't know why they're not eating " it could be related to breathing, sucking, swallowing, coordination or other reasons. Gastroesophageal reflux (GER) is also another common problem among infants who are still learning to swallow " it's important we understand how they can protect their airways during swallowing and during reflux."

"Understanding the way infants' swallowing and esophageal functions work and develop is the first step in identifying the reasons these infants aren't eating and subsequently treating the real problem so it doesn't become a long-term issue. The development of an infant-size specific catheter and innovative methods to elicit nerve muscle interaction was a critical component of this, and future research," added Dr. Jadcherla.

For this study, Dr. Jadcherla studied 18 healthy premature infants at two different times, 33 and 36 weeks old (the average birth age was 30 weeks), using a novel technique that tested the baby's reflexes mediated by the vagus nerve (the longest of the cranial nerves, which travels from the brain stem through the organs in the neck, thorax and abdomen) when stimulated by different substances including air, water and apple juice. The apple juice was used to simulate responses to more acidic substances.

The results of the study showed that at 33 weeks, an infant's motor responses reacted when provoked and the responses improved with development. Using this new knowledge, Dr. Jadcherla intends to begin focusing on premature infants with other health-related issues to eliminate longer-term problems. "When the infants are released early from the NICU, they spend time learning how to eat, and often this can be associated with increases in hospitalizations and a financial burden for families," said Dr. Jadcherla. "By studying healthy infants first, we can apply our learning to feeding problems among infants with other concerns."

Columbus Children's Hospital ranks among the top 10 in National Institutes of Health research awards and grants to freestanding children's hospitals in the country. With nearly 500,000 patient visits each year, Children's Hospital is a 111-year-old pediatric healthcare network treating newborns through age 21. In 2002, the Children's Research Institute conducted more than 250 research projects and is the home of the Center for Injury Research and Policy along with other Centers of Emphasis encompassing gene therapy; molecular and human genetics; vaccines and immunity; childhood cancer; cell and vascular biology; developmental pharmacology and toxicology; and biopathology. Pediatric Clinical Trials International (PCTI), a site management organization affiliated with the hospital, also coordinated more than 50 clinical trials. In addition to having one of the largest ambulatory programs in the country, Children's offers specialty programs and services. Each year, more than 75,000 consumers receive health and wellness education, and 2,000 students from 93 institutions and 500 residents receive training at Children's. More information on Children's Hospital of Columbus is available by calling (614) 722-KIDS (5437), or through the hospital's Web site.