The effect of sensory intervention on swallowing and respiration through neurological maturation in preterm infants

感觉干预通过神经成熟对早产儿吞咽和呼吸的影响

• 批准号: 10401808
• 负责人: Rebecca Z German
• 金额: $ 57.01万
• 依托单位: NORTHEAST OHIO MEDICAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10401808
• 关键词: Affect; Aftercare; Age; Animal Model; Aspirate substance; Behavior; Behavior Therapy; Birth; Bottle feeding; Brain; Breathing; Continuous Positive Airway Pressure; Deglutition; Deglutition Disorders; Development; Effectiveness; Electromyography; Family suidae; Gestational Age; Goals; Health; Human; Individual; Infant; Ingestion; Intervention; Long-Term Effects; Methods; Milk; Mission; Nervous system structure; Neurologic; Oral; Oropharyngeal; Outcome; Outcome Measure; Patients; Periodicity; Physiological; Physiology; Play; Population; Premature Infant; Research; Respiration; Role; Safety; Sensory; Speed; Stimulus; Study models; System; Testing; Therapeutic Intervention; Translations; United States National Institutes of Health; Weaning; Work; age group; base; effective intervention; effectiveness evaluation; effectiveness testing; feeding; improved; infancy; novel therapeutic intervention; nutrition; oral sensory; premature; rehabilitation strategy; respiratory; sensorimotor control mechanism; sensory stimulus; success; sucking; treatment duration

Sucking, swallowing, and their coordination with breathing, are often compromised in preterm infants, yet are critical to their long-term health outcomes. Current work suggests that external oral sensory stimuli induce rhythmic sucking, and that such stimuli hold potential as rehabilitation strategies. However, our understanding of the impact of these interventions on aerodigestive function is limited because human preterm infants are a fragile research population, with restrictions on experimental manipulations. We also do not know the role that the degree of prematurity and the subsequent neurological maturation of the preterm infant brain plays in determining the effectiveness of oral stimulation in facilitating feeding. Thus, the translation of these promising results into effective interventions for promoting sustained oral feeding in preterm infants is inadequate. Using an animal model of preterm infants, we propose to test how nutritive stimulation, in the form of rhythmic milk delivery, functions as an intervention for improving aerodigestive function. We will test two factors that may determine the success of this intervention: the duration of intervention and degree of prematurity. We will apply the intervention for either a short term (early infancy) or for a longer term (entire infancy prior to weaning). Within each treatment duration, there will be two independent age groups, defined by respiratory status at birth: (1) capable of independent respiration or (2) requiring bubble CPAP ventilation support. We will compare these infants to bottle fed individuals who receive only non-nutritive stimulation and to individuals who are only bottle fed. We have proven and validated this model for studying aerodigestive function in preterm infants, as well as the interventions proposed. The experimental methods will include high-speed biplanar videoflurography, electromyography and respiration, from which we will extract outcome variables assessing airway protection, rhythmicity of respiration, sucking and swallowing, and coordination amongst these behaviors. The significance of this work is the determination of how, and at what age, oral stimuli change the function and the underlying physiology of preterm infant feeding- respiration coordination. By testing the relationship between infant neuromotor maturation and the effectiveness of stimulation-based treatment, this work will provide a basis for the subsequent development of new therapeutic interventions for neurological and physiological complications which affect feeding in all infants.

吮吸，吞咽和与呼吸的协调经常被妥协 早产儿，但对于他们的长期健康状况至关重要。当前的工作建议 这种外部口服感觉刺激会引起节奏吮吸，并保持这种刺激 潜在的康复策略。但是，我们对这些影响的理解 关于机动化功能的干预措施受到限制，因为人早产是一个 脆弱的研究人群，受到实验操作的限制。我们也不 知道早产程度和随后的神经系统成熟的作用 早产婴儿大脑在确定口服刺激有效性方面发挥了作用 促进喂养。因此，这些有希望的结果的翻译为有效 促进早产儿持续口服喂养的干预措施不足。使用一个 早产儿的动物模型，我们建议测试营养刺激的方式 有节奏的牛奶递送，作为改善机动化功能的干预措施。我们 将测试两个可能决定这种干预成功的因素： 干预和早产程度。我们将在短期内应用干预措施 （婴儿期）或长期（断奶之前的整个婴儿期）。在每种治疗中 持续时间，将有两个独立的年龄组，由出生时呼吸状态定义：（1） 能够独立呼吸或（2）需要气泡CPAP通气支持。我们将 将这些婴儿与仅接受非营养刺激的人进行比较 以及只有奶瓶的人。我们已经证明并验证了此模型 研究早产儿以及提出的干预措施中的机化功能。这 实验方法将包括高速双翼视频术，肌电图 和呼吸，我们将从中提取评估气道保护的结果变量， 呼吸，吮吸和吞咽和协调的节奏 行为。这项工作的意义是确定如何以及在几岁时的口头 刺激改变了早产婴儿喂养的功能和潜在生理学 呼吸协调。通过测试婴儿神经运动成熟之间的关系 以及基于刺激的治疗的有效性，这项工作将为 随后开发用于神经和生理的新治疗干预措施 影响所有婴儿喂养的并发症。