Sudarshan R Jadcherla1,2,3, Kathryn A Hasenstab1,2, Reza Shaker4, Robert G Castile1,2,5. 1. The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Nationwide Children's Hospital Research Institute, Columbus, Ohio. 2. The Neonatal Aerodigestive Pulmonary Program, Nationwide Children's Hospital, Columbus, Ohio. 3. Divisions of Neonatology, Pediatric Gastroenterology and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio. 4. Gastroenterology and Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. 5. Division of Respiratory Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
Abstract
BACKGROUND: Cough and deglutition are protective mechanisms that defend against aspiration. We identified mechanisms associated with cough provocation as well as those associated with cough resolution in infants with bronchopulmonary dysplasia (BPD). METHODS: Manometry signatures of cough were recognized in 16 premature infants with BPD undergoing concurrent esophageal manometry, respiratory inductance plethysmography, and nasal air flow measurements. Pretussive and post-tussive pharyngo-esophageal motility changes were analyzed. Mechanisms associated with cough and mechanisms that restored respiratory and esophageal normalcy were analyzed. RESULTS: We analyzed 312 cough events during 88 cough clusters; 97% were associated with recognizable manometric patterns. Initial mechanisms related with coughing included nonpropagating swallow (59%), upper esophageal sphincter (UES) reflex contraction (18%), and lower esophageal sphincter (LES) relaxation (14%). UES and LES dysfunction was present in 69% of nonpropagating swallow-associated cough clusters. Mechanisms restoring post-tussive normalcy included primary peristalsis (84%), secondary peristalsis (8%), and none recognized (8%). UES contraction reflex was associated with cough clusters more frequently in infants on nasal continuous positive airway pressure (NCPAP) (OR = 9.13, 95% CI = 1.88-44.24). CONCLUSION: Cough clusters in infants with BPD had identifiable etiologies associated with esophageal events; common initial mechanisms were of upper aerodigestive origin, while common clearing mechanisms were peristaltic reflexes.
BACKGROUND: Cough and deglutition are protective mechanisms that defend against aspiration. We identified mechanisms associated with cough provocation as well as those associated with cough resolution in infants with bronchopulmonary dysplasia (BPD). METHODS: Manometry signatures of cough were recognized in 16 premature infants with BPD undergoing concurrent esophageal manometry, respiratory inductance plethysmography, and nasal air flow measurements. Pretussive and post-tussive pharyngo-esophageal motility changes were analyzed. Mechanisms associated with cough and mechanisms that restored respiratory and esophageal normalcy were analyzed. RESULTS: We analyzed 312 cough events during 88 cough clusters; 97% were associated with recognizable manometric patterns. Initial mechanisms related with coughing included nonpropagating swallow (59%), upper esophageal sphincter (UES) reflex contraction (18%), and lower esophageal sphincter (LES) relaxation (14%). UES and LES dysfunction was present in 69% of nonpropagating swallow-associated cough clusters. Mechanisms restoring post-tussive normalcy included primary peristalsis (84%), secondary peristalsis (8%), and none recognized (8%). UES contraction reflex was associated with cough clusters more frequently in infants on nasal continuous positive airway pressure (NCPAP) (OR = 9.13, 95% CI = 1.88-44.24). CONCLUSION: Cough clusters in infants with BPD had identifiable etiologies associated with esophageal events; common initial mechanisms were of upper aerodigestive origin, while common clearing mechanisms were peristaltic reflexes.
Authors: Eneysis M Pena; Vanessa N Parks; Juan Peng; Soledad A Fernandez; Carlo Di Lorenzo; Reza Shaker; Sudarshan R Jadcherla Journal: Am J Physiol Gastrointest Liver Physiol Date: 2010-09-23 Impact factor: 4.052
Authors: Barbara J Stoll; Nellie I Hansen; Edward F Bell; Seetha Shankaran; Abbot R Laptook; Michele C Walsh; Ellen C Hale; Nancy S Newman; Kurt Schibler; Waldemar A Carlo; Kathleen A Kennedy; Brenda B Poindexter; Neil N Finer; Richard A Ehrenkranz; Shahnaz Duara; Pablo J Sánchez; T Michael O'Shea; Ronald N Goldberg; Krisa P Van Meurs; Roger G Faix; Dale L Phelps; Ivan D Frantz; Kristi L Watterberg; Shampa Saha; Abhik Das; Rosemary D Higgins Journal: Pediatrics Date: 2010-08-23 Impact factor: 7.124
Authors: Y Xiao; D Carson; L Boris; J Mabary; Z Lin; F Nicodème; M Cuttica; P J Kahrilas; J E Pandolfino Journal: Dis Esophagus Date: 2013-02-26 Impact factor: 3.429
Authors: Sudarshan R Jadcherla; Theresa R Shubert; Ish K Gulati; Preceousa S Jensen; Lai Wei; Reza Shaker Journal: Pediatr Res Date: 2014-10-03 Impact factor: 3.756
Authors: Maneesha Sivalingam; Swetha Sitaram; Kathryn A Hasenstab; Lai Wei; Frederick W Woodley; Sudarshan R Jadcherla Journal: Dysphagia Date: 2017-04-01 Impact factor: 3.438
Authors: Sudarshan R Jadcherla; Kathryn A Hasenstab; Swetha Sitaram; Brian J Clouse; Jonathan L Slaughter; Reza Shaker Journal: Am J Physiol Gastrointest Liver Physiol Date: 2016-03-24 Impact factor: 4.052