Advances in Swallowing Neurophysiology across Pediatric Development: Current Evidence and Insights

Effects of supplemental oxytocin on feeding and swallowing maturation in rats

Background

Pediatric dysphagia is a prominent feature of neurodevelopmental disorders, such as Prader-Willi syndrome (PWS). Dysphagia increases the risk of malnutrition, aspiration, and subsequent respiratory infections, highlighting the importance of improving the understanding and management of dysphagia.

Aim

The present study investigated the potential role of oxytocin (OXT) in advancing feeding and swallowing behaviors in postnatal day 0 (P0) to P42 (6-week-old) rats, with potential therapeutic implications for PWS. We hypothesized that OXT administered subcutaneously in Sprague Dawley rats within 12 to 24 hours of birth would accelerate the maturation of feeding and swallowing behaviors compared to naïve and saline-treated controls.

Methods

Importantly, the videofluoroscopic swallow study (VFSS) protocol was successfully adapted to evaluate rats as young as P21, broadening the application of this protocol beyond the previous limitation of 6-week-old rats. Using an adapted VFSS protocol for juvenile (P21-P35) and peripubertal (P36-P42) rats, feeding and swallowing maturation was objectively characterized using custom JawTrack™ software. Protocol adaptations included the refinement of oral contrast formulations for liquid and solid foods and the optimization of fluoroscope settings and equipment. Body weight and developmental milestones (e.g., crawling, walking, self-feeding) were also recorded.

Results

OXT modulated specific feeding behaviors in juvenile rats (i.e., lick rate and inter-lick interval). However, OXT did not significantly accelerate the attainment of developmental milestones in rats, and the selective effects on feeding behaviors were not observed to extend into the peripubertal stage.

Conclusion

The present study establishes a useful methodology for future research using our enhanced VFSS protocol. In light of these results, future research is well-positioned to expand our understanding of the potential of OXT to treat dysphagia in neurodevelopmental disorders.

Research progress in the application of pressing needle embedding needle in dysphagia after stroke: A review

Stroke is characterized by "three highs," and dysphagia is a common dysfunction after stroke. Although some patients can gradually recover from dysphagia with the prolongation of the course of the disease, it is easy to change the prognosis of patients due to complications in the early stage of the disease, and clinical research has shown that pressing needle embedding needles can improve the outcome of patients with dysphagia after stroke. We reviewed the clinical related literature on the treatment of dysphagia after stroke by pressing needle and embedding needle in recent years. The application of press needle embedding can improve swallowing function after stroke, and have more significant effects, which can change the clinical outcome of patients. Pressing needle embedding has significant clinical advantages in the treatment of dysphagia after stroke, which can improve the prognosis of patients.

Complementary feeding practices of caregivers of infants with Down syndrome as compared to caregivers of typically developing infants

Caregiver feeding practices during the complementary feeding period (6 months-2 years) may be particularly important for infants with Down syndrome (DS) as they are at higher risk for later health conditions (e.g., obesity, diabetes) that can be influenced by early feeding practices. However, how well caregivers of infants with DS are meeting infant feeding evidence-based practices is relatively unknown. Caregivers of infants with DS (N = 75) and caregivers of typically developing (TD) infants (N = 66) aged 0-2 years completed an online survey about their infant feeding practices and information sources. Caregiver practices and information sources were statistically compared between groups. Results indicated that there are significant differences in the feeding practices of caregivers of infants with DS when compared to caregivers of TD infants. Caregivers of infants with DS were less likely to meet infant feeding evidence-based practices than caregivers of TD infants. Caregivers of infants with DS were also more concerned about their infant's food intake and later weight status. Some individual feeding practices also significantly differed between groups, with caregivers of infants with DS more likely to meet evidence-based practices of purchasing iron rich foods and avoiding added salt, but less likely to use responsive feeding practices than caregivers of TD infants. Caregivers of infants with DS were also less likely to receive information about how to navigate the complementary feeding period than caregivers of TD infants. Coupled with existing research, the results of the present study suggest that infant feeding evidence-based practices should be reviewed for their appropriateness for this population and additional support for caregivers of infants with DS should be implemented to help them navigate this important period.

Feeding and swallowing outcomes of children receiving long-term ventilation: A scoping review protocol

BACKGROUND

The last three decades have seen a growth in the number of children requiring long-term ventilation. Children with long-term ventilation present with underlying respiratory and neurological conditions that place them at risk of feeding and swallowing difficulties. To date, a scoping review or systematic review investigating the feeding and swallowing outcomes of children with long-term ventilation needs has not been conducted.

AIMS

This paper describes a protocol for a scoping review of the feeding and swallowing outcomes of children receiving long-term ventilation.

METHODS

This scoping review protocol will utilize the Joanna Briggs Institute scoping review methodology guideline. Our review will focus on the feeding and swallowing outcomes of children aged 0 to 18 years with long-term ventilation needs. A full search strategy initially created by the authors and a research librarian was conducted on the PubMed database. Following this, pilot testing took place to determine discrepancies in eligibility criteria. A full search strategy will be conducted across several databases. A data extraction form has been developed by the authors and will be used during the scoping review process.

DISCUSSION

This protocol has been created to provide a rigorous and comprehensive basis for undertaking a scoping review. All necessary steps have been completed in order to commence the scoping review.

REGISTRATION

This scoping review protocol was registered on Open Science Framework on the 26th November 2021 (Registration DOI 10.17605/OSF.IO/NQBPD).

Prevalence and Impact of Feeding-Related Events on Hospital Stay in Preterm and Term Newborns

BACKGROUND

Nursing assessment of milk flow regulation and associated apnea, bradycardia, and desaturation (ABD events) contribute to considerations for the discharge of newborns from the acute care setting. Research regarding infant feeding-related (FR) events (sucking and swallowing difficulties) and ABD events in moderate to late-preterm and full-term infants is lacking.

PURPOSE

This study observes the impact of FR and ABD events during feeding on hospital length of stay (LOS) and healthcare utilization (cost) in moderate-to-late preterm newborns, as well as full-term infants.

METHODS

In a retrospective study, bottle-fed infants admitted to the level II specialty care nursery of an academic community hospital in Southern California were observed for FR and ABD events. Statistical analyses were used to determine the impact of FR events on adjusted LOS, to evaluate the interaction between FR event status and adjusted LOS on total hospital charges, and to assess the statistical independence between FR events and diagnostic-related group severity.

RESULTS

The full sample of patient records included 308 infants born between 32- and 44-week gestational age between April 1, 2018, and October 31, 2022. LOS was twice as long in infants who had FR events. Total median charges were higher in the group with FR events at $160,165 versus $64,380 with non-FR events.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Increased knowledge in the epidemiology and nursing care of infants experiencing milk flow regulation and associated ABD events is critical for informing practices and guidelines related to the prevention of related morbidities.