Document Detail

The role of swallowing during active sleep in the clearance of reflux in term and preterm infants.
MedLine Citation:
PMID:  11035836     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To investigate swallowing and peristalsis in sleep and during gastroesophageal reflux (GER) in both healthy term and preterm infants at term equivalent age. STUDY DESIGN: Multichannel recordings were made in 12 healthy term and 11 preterm infants, under the same conditions, after feeding. Sleep state, cardiorespiratory variables, esophageal pH, and pharyngeal swallowing and peristalsis were measured. GER was defined as pH <4 for > or = 15 seconds, and swallows were classified as pharyngeal only, primary peristalsis (propagated, dropped, interrupted), or secondary peristalsis. RESULTS: Spontaneous swallowing rate was not significantly different between term and preterm infants and was sleep state-related, occurring in active sleep but rarely in quiet sleep. In response to acid GER, term infants significantly increased pharyngeal swallowing from a median of 0.7 (25th-75th interquartile range, 0.5-0.9) to 1.7 (1.0-3.0) swallows/min and secondary peristalsis from a median of 0.5 (25th-75th interquartile range, 0.3-0.8) to 1.1 (0.8-2.0) waves/min (P <.05). In contrast, the preterm infants demonstrated a significantly higher proportion of fully propagated peristaltic swallows compared with the term infants (53% and 27%, respectively) (P <.05). CONCLUSION: The occurrence of swallowing is sleep state-related. In active sleep, term infants clear GER by increasing swallowing and secondary peristalsis, whereas preterm infants at term equivalent age clear GER by increasing propagated peristalsis. This method of clearance would explain the mechanism by which preterm infants have significantly shorter episodes of reflux than term infants.
H E Jeffery; D Ius; M Page
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of pediatrics     Volume:  137     ISSN:  0022-3476     ISO Abbreviation:  J. Pediatr.     Publication Date:  2000 Oct 
Date Detail:
Created Date:  2000-11-28     Completed Date:  2000-11-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  545-8     Citation Subset:  AIM; IM    
Department of Neonatal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
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MeSH Terms
Deglutition / physiology*
Gastroesophageal Reflux / physiopathology*
Infant, Newborn
Infant, Premature*
Peristalsis / physiology*

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