Mechanisms of bradycardia in premature infants: Aerodigestive–cardiac regulatory–rhythm interactions
Abstract Objective Eating difficulties coupled with cardiorespiratory spells delay acquisition of feeding milestones in convalescing neonates, and the mechanisms are unclear. Aims were to examine and compare the pharyngoesophageal–cardiorespiratory (PECR) response characteristics: (a) in control neo...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-07-01
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| Series: | Physiological Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.14814/phy2.14495 |
| _version_ | 1828945012031750144 |
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| author | Kathryn A. Hasenstab‐Kenney Jenny Bellodas Sanchez Varsha Prabhakar Ivan M. Lang Reza Shaker Sudarshan R. Jadcherla |
| author_facet | Kathryn A. Hasenstab‐Kenney Jenny Bellodas Sanchez Varsha Prabhakar Ivan M. Lang Reza Shaker Sudarshan R. Jadcherla |
| author_sort | Kathryn A. Hasenstab‐Kenney |
| collection | DOAJ |
| description | Abstract Objective Eating difficulties coupled with cardiorespiratory spells delay acquisition of feeding milestones in convalescing neonates, and the mechanisms are unclear. Aims were to examine and compare the pharyngoesophageal–cardiorespiratory (PECR) response characteristics: (a) in control neonates and those with recurrent bradycardia spells; and (b) during pharyngeal stimulation when bradycardia occurs versus when no bradycardia occurs. Methods Preterm infants (N = 40, 27 ± 3 weeks gestation), underwent concurrent pharyngoesophageal manometry, electrocardiography, respiratory inductance plethysmography, and nasal airflow thermistor to evaluate pharyngoesophageal motility, heart rate (HR), and respiration during graded abrupt pharyngeal sterile water stimuli. Infants with recurrent bradycardia (N = 28) and controls (N = 12) were evaluated at 38 (38–40) and 39 (38–40) weeks postmenstrual age, respectively. Comparisons were performed (a) between study and control groups; and (b) among HR responses of <80 BPM, 80–100 BPM, and >100 BPM. Results Overall, characteristics of PECR responses in infants with a history of recurrent bradycardia (vs. controls) did not differ (p > .05). However, when pharyngeal stimulus induced severe bradycardia (<80 BPM): prolonged respiratory rhythm change, increased pharyngeal activity, increased esophageal dysmotility (as evidenced by prolonged esophageal inhibition and motor activity), and prolonged lower esophageal sphincter relaxation were noted (all p < .05). Conclusions In control infants and those with recurrent bradycardia, pharyngeal stimulation results in similar PECR response characteristics. However, when severe bradycardia occurs, PECR response characteristics are distinct. The mechanisms of severe bradycardia spells are related to abnormal prolongation of vagal inhibitory effects on cardiorespiratory rhythms in conjunction with prolonged esophageal inhibition and delays with terminal swallow. |
| first_indexed | 2024-12-14T04:44:21Z |
| format | Article |
| id | doaj.art-a544e77a681346139a572b3559b5c29f |
| institution | Directory Open Access Journal |
| issn | 2051-817X |
| language | English |
| last_indexed | 2024-12-14T04:44:21Z |
| publishDate | 2020-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Physiological Reports |
| spelling | doaj.art-a544e77a681346139a572b3559b5c29f2022-12-21T23:16:43ZengWileyPhysiological Reports2051-817X2020-07-01813n/an/a10.14814/phy2.14495Mechanisms of bradycardia in premature infants: Aerodigestive–cardiac regulatory–rhythm interactionsKathryn A. Hasenstab‐Kenney0Jenny Bellodas Sanchez1Varsha Prabhakar2Ivan M. Lang3Reza Shaker4Sudarshan R. Jadcherla5Innovative Neonatal and Infant Feeding Disorders Research Program Center for Perinatal Research The Research Institute at Nationwide Children's Hospital Columbus OH USAInnovative Neonatal and Infant Feeding Disorders Research Program Center for Perinatal Research The Research Institute at Nationwide Children's Hospital Columbus OH USAInnovative Neonatal and Infant Feeding Disorders Research Program Center for Perinatal Research The Research Institute at Nationwide Children's Hospital Columbus OH USAMCW Dysphagia Institute Division of Gastroenterology and Hepatology Department of Medicine Medical College of Wisconsin Milwaukee WI USAMCW Dysphagia Institute Division of Gastroenterology and Hepatology Department of Medicine Medical College of Wisconsin Milwaukee WI USAInnovative Neonatal and Infant Feeding Disorders Research Program Center for Perinatal Research The Research Institute at Nationwide Children's Hospital Columbus OH USAAbstract Objective Eating difficulties coupled with cardiorespiratory spells delay acquisition of feeding milestones in convalescing neonates, and the mechanisms are unclear. Aims were to examine and compare the pharyngoesophageal–cardiorespiratory (PECR) response characteristics: (a) in control neonates and those with recurrent bradycardia spells; and (b) during pharyngeal stimulation when bradycardia occurs versus when no bradycardia occurs. Methods Preterm infants (N = 40, 27 ± 3 weeks gestation), underwent concurrent pharyngoesophageal manometry, electrocardiography, respiratory inductance plethysmography, and nasal airflow thermistor to evaluate pharyngoesophageal motility, heart rate (HR), and respiration during graded abrupt pharyngeal sterile water stimuli. Infants with recurrent bradycardia (N = 28) and controls (N = 12) were evaluated at 38 (38–40) and 39 (38–40) weeks postmenstrual age, respectively. Comparisons were performed (a) between study and control groups; and (b) among HR responses of <80 BPM, 80–100 BPM, and >100 BPM. Results Overall, characteristics of PECR responses in infants with a history of recurrent bradycardia (vs. controls) did not differ (p > .05). However, when pharyngeal stimulus induced severe bradycardia (<80 BPM): prolonged respiratory rhythm change, increased pharyngeal activity, increased esophageal dysmotility (as evidenced by prolonged esophageal inhibition and motor activity), and prolonged lower esophageal sphincter relaxation were noted (all p < .05). Conclusions In control infants and those with recurrent bradycardia, pharyngeal stimulation results in similar PECR response characteristics. However, when severe bradycardia occurs, PECR response characteristics are distinct. The mechanisms of severe bradycardia spells are related to abnormal prolongation of vagal inhibitory effects on cardiorespiratory rhythms in conjunction with prolonged esophageal inhibition and delays with terminal swallow.https://doi.org/10.14814/phy2.14495apneabradycardiacardiorespiratory and life‐threatening eventspharyngoesophageal manometryswallowing |
| spellingShingle | Kathryn A. Hasenstab‐Kenney Jenny Bellodas Sanchez Varsha Prabhakar Ivan M. Lang Reza Shaker Sudarshan R. Jadcherla Mechanisms of bradycardia in premature infants: Aerodigestive–cardiac regulatory–rhythm interactions Physiological Reports apnea bradycardia cardiorespiratory and life‐threatening events pharyngoesophageal manometry swallowing |
| title | Mechanisms of bradycardia in premature infants: Aerodigestive–cardiac regulatory–rhythm interactions |
| title_full | Mechanisms of bradycardia in premature infants: Aerodigestive–cardiac regulatory–rhythm interactions |
| title_fullStr | Mechanisms of bradycardia in premature infants: Aerodigestive–cardiac regulatory–rhythm interactions |
| title_full_unstemmed | Mechanisms of bradycardia in premature infants: Aerodigestive–cardiac regulatory–rhythm interactions |
| title_short | Mechanisms of bradycardia in premature infants: Aerodigestive–cardiac regulatory–rhythm interactions |
| title_sort | mechanisms of bradycardia in premature infants aerodigestive cardiac regulatory rhythm interactions |
| topic | apnea bradycardia cardiorespiratory and life‐threatening events pharyngoesophageal manometry swallowing |
| url | https://doi.org/10.14814/phy2.14495 |
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