The survival of preterm infants born at less than 33 weeks gestational age (GA) has increased dramatically over the past decade, but these infants are likely to exhibit impaired swallowing (termed dysphagia) when they begin oral feeding. Half will continue to exhibit dysphagia after 36 weeks, when full volume oral feedings should be achieved without difficulty. Dysphagia has significant clinical consequences, including malnutrition, growth retardation, and risk of pneumonia associated with taking fluid into the airway. Dysphagia among preterm infants is more pronounced when swallowing thin fluids. Due to their CNS immaturity, preterm infants may have greater difficulty detecting the flow properties of thin fluids. Subjects are dysphagic preterm infants, born less than 33 weeks GA, initially referred by a physician between 36 to 42 weeks to Children's Hospital for a videofluoroscopic swallowing study (VFSS). The specific aims of this project are to test three hypotheses concerning swallowing and airway protection as preterm infants swallow thin or thick fluids during VFSS. Two hypotheses are tested at a 36 to 42 week VFSS: (1) aspiration of fluid will be more likely to occur during swallows in which there is poor coordination between a swallow gesture (e.g., the tongue base sealing the airway) and fluid bolus movement, and (2) timing of swallow movements will be less well coordinated with fluid bolus transit when swallowing thin fluids compared to thick fluids. The third hypothesis is tested at a follow-up three month VFSS for infants who exhibited fluid aspiration during the 36 to 42 week evaluation, and who were prescribed a thickened formula for home feedings: (3) at three months, compared to the initial VFSS, there will be improved coordination between swallow movements and bolus transit and no fluid aspiration. The study hypotheses are tested by experimental manipulation of barium sulfate viscosity during infant swallowing, kinematic analysis of recorded swallow images, and non-radiologic recordings of sucking, swallowing, and breathing.
