Pharyngo-esophageal motility reflex mechanisms in the human neonate: Importance of integrative cross-systems physiology

2021 ◽  
Author(s):  
Zakia Sultana ◽  
Kathryn A. Hasenstab ◽  
Sudarshan R Jadcherla
Keyword(s):  
Esophageal Motility ◽  
Tube Feeding ◽  
Oral Feeding ◽  
Primary Role ◽  
Critical Function ◽  
Feeding Difficulties ◽  
Survival And Development ◽  
Human Neonate ◽  
Systems Physiology

Swallowing is a critical function for survival and development in human neonates, and requires cross-system coordination between neurologic, airway, and digestive motility systems. Development of pharyngo-esophageal motility is influenced by intra- and extra-uterine development, pregnancy complications, and neonatal comorbidities. Primary role of these motility reflex mechanisms is to maintain aerodigestive homeostasis under basal and adaptive biologic conditions including oral feeding, gastroesophageal reflux, and sleep. Failure may result in feeding difficulties, airway compromise, dysphagia, aspiration syndromes, and chronic eating difficulties requiring prolonged tube feeding. We review the integration of cross-systems physiology to describe the basis for physiologic and pathophysiologic neonatal aerodigestive functions.

Feeding and Swallowing Issues in Infants With Craniofacial Anomalies

2016 ◽  
Vol 1 (5) ◽  
pp. 13-26 ◽  
Author(s):  
Claire Kane Miller ◽  
Lauren L. Madhoun
Keyword(s):  
Clinical Signs ◽  
Oral Feeding ◽  
Deletion Syndrome ◽  
Feeding Strategies ◽  
Primary Role ◽  
Craniofacial Anomalies ◽  
Airway Protection ◽  
Feeding Difficulties ◽  
Oral Motor ◽  
Swallowing Dysfunction

The problems with feeding and swallowing that occur as a result of clefts and craniofacial anomalies range in severity. The extent of clefting, as well as other structural, airway, and neurologic issues, are factors that contribute to potential difficulty with oral feeding mechanics and with the integrity of airway protection during swallowing. Oral motor dysfunction in conjunction with obstruction in the upper airway secondary to anatomic or physiologic anomalies has the potential to cause serious disruption to the necessary coordination of respiration and swallowing. Timely identification of problems is necessary to address threats to nutritional status and/or respiratory health. The pediatric speech-language pathologist has a primary role in the clinical assessment of oral motor/feeding skills, and in the recognition of clinical signs and symptoms of swallowing dysfunction that may warrant referral for instrumental assessment of swallowing function and airway protection. The objective of this article is to summarize the potential feeding difficulties and feeding strategy options for patients with Craniofacial Microsomia, 22q11.2 Deletion Syndrome, Treacher Collins Syndrome, and Pierre Robin Sequence. Awareness of the factors that impact upon the success of feeding and the efficacy of compensatory feeding strategies is key to best practice and successful patient outcomes.

scholarly journals Phosphatidylserine translocation at the yeasttrans-Golgi network regulates protein sorting into exocytic vesicles

2015 ◽  
Vol 26 (25) ◽  
pp. 4674-4685 ◽  
Author(s):  
Hannah M. Hankins ◽  
Yves Y. Sere ◽  
Nicholas S. Diab ◽  
Anant K. Menon ◽  
Todd R. Graham
Keyword(s):  
Plasma Membrane ◽  
Membrane Proteins ◽  
Primary Role ◽  
Plasma Membrane Proteins ◽  
Critical Function ◽  
Oxysterol Binding Protein ◽  
Phosphatidylserine Translocation ◽  
Golgi Network ◽  
Lateral Segregation

Sorting of plasma membrane proteins into exocytic vesicles at the yeast trans-Golgi network (TGN) is believed to be mediated by their coalescence with specific lipids, but how these membrane-remodeling events are regulated is poorly understood. Here we show that the ATP-dependent phospholipid flippase Drs2 is required for efficient segregation of cargo into exocytic vesicles. The plasma membrane proteins Pma1 and Can1 are missorted from the TGN to the vacuole in drs2∆ cells. We also used a combination of flippase mutants that either gain or lose the ability to flip phosphatidylserine (PS) to determine that PS flip by Drs2 is its critical function in this sorting event. The primary role of PS flip at the TGN appears to be to control the oxysterol-binding protein homologue Kes1/Osh4 and regulate ergosterol subcellular distribution. Deletion of KES1 suppresses plasma membrane–missorting defects and the accumulation of intracellular ergosterol in drs2 mutants. We propose that PS flip is part of a homeostatic mechanism that controls sterol loading and lateral segregation of protein and lipid domains at the TGN.

Developing a Quality Improvement Feeding Program for NICU Patients

NeoReviews ◽  
2022 ◽  
Vol 23 (1) ◽  
pp. e23-e35
Author(s):  
Erika K. Osborn ◽  
Sudarshan R. Jadcherla
Keyword(s):  
Quality Improvement ◽  
Clinical Outcomes ◽  
Preterm Infants ◽  
Tube Feeding ◽  
Practice Variation ◽  
Oral Feeding ◽  
Evidence Based ◽  
Feeding Difficulties ◽  
Feeding Program ◽  
Hospital Stays

Practices in NICUs vary widely, particularly when clinical decisions involve complex tasks and multiple disciplines, which occurs with feeding preterm infants. Neonatal feeding difficulties in preterm infants often lead to prolonged tube feeding and therefore lengthened hospital stays. Education and compliance with evidence-based protocols and guidelines are needed on the initiation of feedings and feeding advancement to transform enteral and oral feeding practices and thus reduce practice variation and improve clinical outcomes.

Identification of a Pivotal Period in the Oral Feeding Progression of Preterm Infants

2018 ◽  
Vol 36 (05) ◽  
pp. 530-536 ◽  
Author(s):  
Sandra Fucile ◽  
Sarah Phillips ◽  
Kelly Bishop ◽  
Meagan Jackson ◽  
Taylor Yuzdepski ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Motor Skills ◽  
Tube Feeding ◽  
Time Frame ◽  
Oral Feeding ◽  
High Risk Population ◽  
Feeding Difficulties ◽  
Oral Motor ◽  
Enteral Tube Feeding ◽  
Degree Of Maturity

Objective Preterm infants are at risk of encountering oral feeding difficulties which impede on the transition to independent oral feeds. The objective of this study was to identify a pivotal period where regressions are most likely to occur during their oral feeding progression. Study Design This is a retrospective study on 101 infants born <35 weeks' gestation. The sample was separated into two groups, infants who experienced a regression during their oral feeding progression and those who did not. A pivotal period was defined as a time frame where setbacks (a decrease in oral feed attempts by one) are most likely to occur at the start (1–2 oral feed attempts per day), middle (3–5 oral feed attempts per day), or end (6–8 oral feed attempts per day) of the oral feeding progression. Result Eighty-two percent of infants experienced setbacks; 45% of all setbacks occurred at the middle time frame (p = 0.03). Infants' degree of maturity and enteral tube feeding intolerances were associated with increased occurrence of setbacks (p = 0.04). Conclusion The midpoint in the oral feeding progression is a pivotal period where setbacks are most likely to occur. This time frame can be used by clinicians to evaluate oral-motor skills for earlier provision of interventions to reduce the occurrence of oral feeding difficulties in this high-risk population.

Neurodevelopmental Intervention Strategies to Improve Oral Feeding Skills in Infants With Congenital Heart Defects

2019 ◽  
Vol 4 (6) ◽  
pp. 1492-1497
Author(s):  
Hema Desai ◽  
Audrey N. Lim
Keyword(s):  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Muscle Tone ◽  
Heart Defects ◽  
Tube Feeding ◽  
State Regulation ◽  
Oral Feeding ◽  
Neural Pathways ◽  
Feeding Difficulties ◽  
Feeding Skills

Purpose Full-term infants with congenital heart defects (CHD) are at high risk for developmental and feeding difficulties secondary to a complex combination of immature neurological structures, early surgical intervention, postsurgical complications, and disruption in typical care. Infants with CHD often present with neurobehavioral immaturity that resembles that of premature infants, resulting in difficulties in achieving stability in the physiological and behavioral subsystems. This results in poor arousal, muscle tone abnormalities, and poor state regulation, which affect their ability to achieve oral feeding readiness and progress in their oral feeding skills. In fact, a significant number of infants with CHD require supplemental tube feeding upon hospital discharge to meet their nutritional needs. However, despite these unique barriers, the feeding experience for infants with CHD is frequently overlooked and the focus tends to be on higher level oral motor and swallowing skills and volume intake. Conclusion Given the growing evidence of neurological immaturity and subsequent neurodevelopmental delays in this population, it is crucial for therapists to recognize neurobehavioral stability as a foundation for a complex neuromotor activity such as oral feeding. This article will discuss how to utilize infant neurobehavioral intervention as part of feeding treatment for children with CHD to help develop appropriate neural pathways for oral feeding.

The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

2019 ◽  
Vol 4 (6) ◽  
pp. 1507-1515
Author(s):  
Lauren L. Madhoun ◽  
Robert Dempster
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Hospital Discharge ◽  
Neonatal Intensive Care ◽  
Oral Feeding ◽  
Medical Attention ◽  
Primary Role ◽  
Speech Language Pathologists ◽  
The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

Sports Photography and Historical Development

2018 ◽  
Vol 5 (1) ◽  
pp. 93-115
Author(s):  
Miloš Stamenković
Keyword(s):  
Historical Development ◽  
Emotional Reaction ◽  
Main Role ◽  
Primary Role

SummarySports photography undoubtedly has a significant place in sports press and publicism. It’s main and primary role is to present sports to the readers as art, which it is. Sport is characterized by dynamic and varied movements, and the main role of sports photography is reflected in the fact that it is in this way that sport shows its essence. Having in mind that photography tells more than a thousand words it sends a clear message to the reader as well to people who are informed about events via sports portals. Sports photography is a multidimensional art for many reasons. When we say “multi”, it primarily refers to a wider range that sports photography has to offer, which means sports photography is not only directed at presenting athletes on the move and the main actors who contribute to achieving the results by their engagement – it also has the role of sports “psychophotography” which is an analysis and capture of the emotional reaction of an athlete after winning or losing from the opposing team.

OBOLESCENCE AND THE DIFFUSION OF INNOVATIONS

2020 ◽  
pp. 113-130
Author(s):  
A.V. GOLUBEV ◽  
Keyword(s):  
Diffusion Of Innovations ◽  
Time Lag ◽  
Practical Implementation ◽  
Primary Role ◽  
Innovation Development ◽  
Scientific Hypothesis ◽  
Scientific Papers ◽  
The Moment ◽  
Sociological Studies

The diffusion of innovations is described as a process in a number of scientific papers. At the same time, the causes of this process have not been sufficiently studied. The author’s goal is to consider the main regularities, under which the life cycle of innovations begins, and propose measures to enhance diffusion in modern conditions. As a scientific hypothesis, the author accepts the postulate about the primary role of the obolescence of attracted innovations in this process. The analysis revealed not only the economic proportions that initiate the start of innovation promotion, but also the influence on the diffusion rate of the obsolescence degree of innovations and the market share occupied by the new product. Methodological approaches have been developed to determine economic efficiency depending on the moment of technological change-over, as well as to determine the absolute and relative speed of innovation diffusion. Sociological studies were conducted to determine the state of innovation development and the time lag between obtaining information about an innovation and its practical implementation. The author presents his “Agroopyt” information system developed to disseminate knowledge in the agricultural sphere and ensure technology transfer in agriculture. Digital methods provide for significant accelerateion of the diffusion of innovations and expand its scope.

scholarly journals Four Mutant Alleles Elucidate the Role of the G2 Protein in the Development of C4 and C3 Photosynthesizing Maize Tissues

Genetics ◽  
2001 ◽  
Vol 159 (2) ◽  
pp. 787-797
Author(s):  
Lizzie Cribb ◽  
Lisa N Hall ◽  
Jane A Langdale
Keyword(s):  
Cell Types ◽  
Bundle Sheath ◽  
Primary Role ◽  
Ribulose Bisphosphate Carboxylase ◽  
Sheath Cell ◽  
Mesophyll Cells ◽  
Phenotypic Data ◽  
Bisphosphate Carboxylase ◽  
Bundle Sheath Cell

Abstract Maize leaf blades differentiate dimorphic photosynthetic cell types, the bundle sheath and mesophyll, between which the reactions of C4 photosynthesis are partitioned. Leaf-like organs of maize such as husk leaves, however, develop a C3 pattern of differentiation whereby ribulose bisphosphate carboxylase (RuBPCase) accumulates in all photosynthetic cell types. The Golden2 (G2) gene has previously been shown to play a role in bundle sheath cell differentiation in C4 leaf blades and to play a less well-defined role in C3 maize tissues. To further analyze G2 gene function in maize, four g2 mutations have been characterized. Three of these mutations were induced by the transposable element Spm. In g2-bsd1-m1 and g2-bsd1-s1, the element is inserted in the second intron and in g2-pg14 the element is inserted in the promoter. In the fourth case, g2-R, four amino acid changes and premature polyadenylation of the G2 transcript are observed. The phenotypes conditioned by these four mutations demonstrate that the primary role of G2 in C4 leaf blades is to promote bundle sheath cell chloroplast development. C4 photosynthetic enzymes can accumulate in both bundle sheath and mesophyll cells in the absence of G2. In C3 tissue, however, G2 influences both chloroplast differentiation and photosynthetic enzyme accumulation patterns. On the basis of the phenotypic data obtained, a model that postulates how G2 acts to facilitate C4 and C3 patterns of tissue development is proposed.

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