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Advances with Neonatal Aerodigestive Science in the Pursuit of Safe Swallowing in Infants: Invited Review

Abstract

Feeding, swallowing, and airway protection are three distinct entities. Feeding involves a process of sequential, neurosensory, and neuromotor interactions of reflexes and behaviors facilitating ingestion. Swallowing involves anterograde bolus movement during oral-, pharyngeal-, and esophageal phases of peristalsis into stomach. During these events, coordination with airway protection is vital for homeostasis in clearing any material away from airway vicinity. Neurological–airway-digestive inter-relationships are critical to the continuum of successful feeding patterns during infancy, either in health or disease. Neonatal feeding difficulties encompass a heterogeneous group of neurological, pulmonary, and aerodigestive disorders that present with multiple signs posing as clinical conundrums. Significant research breakthroughs permitted understanding of vagal neural pathways and functional aerodigestive connectivity involved in regulating swallowing and aerodigestive functions either directly or indirectly by influencing the supra-nuclear regulatory centers and peripheral effector organs. These neurosensory and neuromotor pathways are influenced by pathologies during perinatal events, prematurity, inflammatory states, and coexisting medical and surgical conditions. Approaches to clarify pathophysiologic mapping of aerodigestive interactions, as well as translating these discoveries into the development of personalized and simplified feeding strategies to advance child health are discussed in this review article.

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Source: Jadcherla et al. Ped Research 2015

Fig. 4

Source: Jadcherla et al. Ped Research 2015

Fig. 5

Source: Jadcherla, Am J Clin Nutr 2016

Abbreviations

UES:

Upper esophageal sphincter

LES:

Lower esophageal sphincter

GER:

Gastroesophageal reflux

GERD:

Gastroesophageal reflux disease

TLESR:

Transient LES relaxation

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Acknowledgements

Jadcherla’s efforts are supported in part by NIH grants RO1 DK 068158 (Jadcherla) and PO1 DK 068051 (Jadcherla/Lang/Shaker). We are grateful to Kathryn A. Hasenstab, BS BME for assistance with creating figures, artwork, and submission process.

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Correspondence to Sudarshan R. Jadcherla.

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Jadcherla, S.R. Advances with Neonatal Aerodigestive Science in the Pursuit of Safe Swallowing in Infants: Invited Review. Dysphagia 32, 15–26 (2017). https://doi.org/10.1007/s00455-016-9773-z

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Keywords

  • Deglutition
  • Deglutition disorders
  • Infant swallowing
  • GERD
  • Aerodigestive reflexes