678 - Oral Milk Challenge Testing: Impact of Nipple Flow and Milk Thickener on Infant Pharyngo-Esophageal Motility Rhythms

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 678
Publication Number: 678.232

Roseanna Helmick, Nationwide Children's Hospital, Columbus, OH, United States; Kathryn A.. Hasenstab, Nationwide Children's Hospital, Columbus, OH, United States; Erika K. Osborn, Nationwide Children's Hospital, Canal Winchester, OH, United States; Enas Alshaikh, Nationwide Children's Hospital, Pickerington, OH, United States; Sudarshan Jadcherla, Nationwide Children's Hospital, Columbus, OH, United States

Presenting Author(s)

Roseanna Helmick, B.S. (she/her/hers)

Senior Research Associate
Nationwide Children's Hospital
Columbus, Ohio, United States

Background: Common therapies for infant eating and swallowing difficulties include modifications to bottle nipple flow rate or fluid thickness of nutrients. It is unknown how these interventions impact swallowing functions or their mechanisms.

Objective: Therefore, our aims were to evaluate and compare the effects of modified nipple flow or fluid thickness on pharyngeal-esophageal regulatory and motor characteristics in relation to oral intake.

Design/Methods: Hospitalized infants with feeding difficulties (N=12), born at 36.4 ± 3.8 weeks gestation, underwent pharyngo-esophageal motility testing protocols at 48.0 ± 5.6 weeks postmenstrual age to evaluate sensory-motor and regulatory swallowing characteristics (pharyngeal and esophageal contractile strength, duration, activity, variability, bursts, and rhythm) during oral milk challenge (OMC) testing concurrent with high resolution pharyngo-esophageal manometry (HRPM) study protocol implementation. Each infant had four one-minute OMC testing protocols that included changes to nipple flow (slower or faster) and/or fluid thickness (formula with 0 tsp/oz or 1.5 tsp/oz of infant rice cereal). Specifically, we compared within and between the entities: un-thickened feed with slower flow nipple and with faster flow nipple, and thickened feed with slower flow nipple and with faster flow nipple.

Results:

OMC durations during HRPM averaged 71 ± 31 seconds per trial and did not differ between interventions (P >0.05). Effects of nipple flow and fluid thickness interventions on pharyngo-esophageal regulatory and motor functions are shown in Table 1 and Figure 1. Note that swallowing regulatory functions are impacted by the interaction of nipple flow rate and fluid thickness (P< 0.05).

Conclusion(s): During oral milk challenge testing, pharyngeal contractile activity and frequency is lesser with thickened formula. Pharyngo-esophageal motor function was not impacted by nipple flow rate. Thickener delays swallowing and increases the variability, whereas faster flow increases the frequency of swallowing within bursts.