Abstract
Background
Pharyngeal contractility is critical for safe bolus propulsion. Pharyngeal contractile vigor can be measured by Pharyngeal Contractile Integral (PhCI): product of mean pharyngeal contractile amplitude, length, and duration. We characterized PhCI in neonates and examined the hypothesis that PhCI differs with mode of stimulation.
Methods
Nineteen neonates born at 38.6 (34–41) weeks gestation were evaluated at 42.9 (40.4–44.0) weeks postmenstrual age using high-resolution manometry (HRM). PhCI was calculated using: (a) Conventional and (b) Automated Swallow Detection algorithm (ASDA) methods. Contractility metrics of all pharyngeal regions were examined using mixed statistical models during spontaneous and adaptive state (pharyngeal and oral stimulus) swallowing.
Results
PhCI of oral stimuli swallows were distinct from pharyngeal stimuli and spontaneous swallows (P < 0.05). Correlation between conventional and ASDA methods was high (P < 0.001). PhCI increased with swallows for pharyngeal stimulation (P < 0.05) but remained stable for swallows with oral stimulation. PhCI differed between proximal and distal pharynx (P < 0.001).
Conclusions
PhCI is a novel reliable metric capable of distinguishing (1) proximal and distal pharyngeal activity, (2) effects of oral and pharyngeal stimulation, and (3) effects of prolonged stimulation. Changes in pharyngeal contractility with maturation, disease, and therapies can be examined with PhCI.
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Acknowledgements
We are grateful to Carissa Collins, BS, BME, for technical support with manometric waveforms and contour plots; Brittany Durr, RN, MHA, for clinical coordination efforts and data extraction; and Lai Wei, PhD for statistical consultations. This study was supported in part by National Institutes of Health Grants RO1 DK-068158 (Jadcherla) and PO1 DK-068051 (Shaker, Lang, Jadcherla)
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S.R.J. developed the concepts, study design, obtained grant funding and ethical approvals from IRB. M.K., G.B., and R.S. were also associated in concepts. S.R.J. and K.A.H. performed high-resolution pharyngeal manometry studies for data acquisition. S.R.J., V.P., K.A.H., and S.N. performed data analysis. V.P. developed automated analytical algorithms. S.N. performed statistical analysis and interpretation. J.D. provided guidance with mathematical concepts and analytical algorithms. S.R.J., V.P., K.A.H., S.N., J.D., M.K., G.B., and R.S. performed data verification and interpretation. V.P., K.A.H., and S.N. created figures and tables. S.R.J., V.P., K.A.H., S.N., J.D., M.K., G.B., and R.S. were involved with manuscript writing, editing, and approval of final version.
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Jadcherla, S.R., Prabhakar, V., Hasenstab, K.A. et al. Defining pharyngeal contractile integral during high-resolution manometry in neonates: a neuromotor marker of pharyngeal vigor. Pediatr Res 84, 341–347 (2018). https://doi.org/10.1038/s41390-018-0097-6
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DOI: https://doi.org/10.1038/s41390-018-0097-6
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