Persistent feeding difficulties among infants with fetal opioid exposure: mechanisms and clinical reasoning. (2nd November 2019)

• Record Type: Journal Article
• Authors: Hart, Brandon J.; Viswanathan, Sreekanth; Jadcherla, Sudarshan R.
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 32:Number 21(2019)
• Page Start: 3633
• Page End: 3639
• Publication Date: 2019-11-02
• Subjects: Opioid -- neonatal abstinence syndrome -- esophageal motility -- dysphagia -- feeding intolerance; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2018.1469614
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Aims: Infants with fetal exposure to opioids have varying pattern of feeding difficulties mainly manifesting as difficulties with aerodigestive adaptation and disruptive feeding behavior. The reasons are unclear; in a pilot study, we determined basal and adaptive pharyngo-esophageal motility in a group of infants with fetal exposure to opioids and persistent feeding difficulties impeding their discharge. Methods: Six infants with fetal opioid exposure compared to 12 controls who underwent basal and adaptive pharyngo-esophageal manometry to characterize the basis for their symptoms. Spontaneous swallows ( N = 180) and pharyngeal stimuli ( N = 113)-induced swallowing responses were analyzed. Results: Resting upper esophageal sphincter (UES) pressure was similar in both the groups, but resting lower esophageal sphincter (LES) pressure was significantly high and it relaxed slowly and inadequately in opioid-exposed infants ( p < .05). Upon pharyngeal provocation, opioid-exposed infants had higher LES nadir pressure, increased duration of esophageal body contraction at proximal-, mid-, and distal-esophagus, as well as greater area under the curve with distal esophageal waveforms, compared to controls (all p < .05). Conclusions: These pilot observations are suggestive of up-regulation of central vagal effects with heightened cholinergic excitatory responses and inadequate relaxation responses at the foregut, and may form the basis for persistent feeding difficulties in opioid-exposed infants. Abnormality with both sensory and motor aspects of vagal reflexes may be contributory.