In the infant population, the complex issues of dysphagia and swallowing remain to be a conundrum when it comes to the care management of this population. The lack of a pathophysiology guided diagnostic and safe feeding management strategies continue to be critical barriers to progress in this field. This proposal will focus on the dynamic changes in the integrative physiology of the neonatal pharynx, upper esophageal sphincter (UES), lower esophageal sphincter (LES) and esophagus during swallowing and GERD. The overall goal of this project is to examine new management approaches of dysphagia in the infant population. This project will address two aims.
Aim 1 : Effectiveness of two feeding strategies on clinical-, safety- and economic- outcomes in dysphagic infants with anterograde aspiration. The goal of this Aim is to develop novel feeding strategies, to improve clinical outcomes and to clarify aerodigestive protective mechanisms in oral-fed infants (under 6 months of age) with abnormalities proven by diagnostic video fluroscopy swallow study (VFSS).
Aim 2 : Mechanisms and Impact of feeding strategies on pharyngeal and esophageal sensitivity of aerodigestive reflexes in dysphagia with or without GERD. The goal of this Aim is to differentiate GERD and its consequences by examining the sensory-motor characteristics of the swallow, various reflexes and aero-digestive coordination using manometric studies.

Public Health Relevance

Current treatment approaches in dysphagic infants aren't likely to be successful because no clear target has been determined. These infants typically also suffer from chronic morbidity, longer hospitalizations, re- admission, and account for an unacceptable health care burden and or anti-GERD therapies. Upon the completion of this project, we hope to have better diagnostic biomarkers and improved feeding management strategies for a better quality of life for both the infant and parents.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Program Projects (P01)
Project #
2P01DK068051-06
Application #
8742109
Study Section
Special Emphasis Panel (ZDK1-GRB-6 (J1))
Project Start
Project End
Budget Start
2014-04-01
Budget End
2015-03-31
Support Year
6
Fiscal Year
2014
Total Cost
$383,851
Indirect Cost
Name
Medical College of Wisconsin
Department
Type
DUNS #
937639060
City
Milwaukee
State
WI
Country
United States
Zip Code
53226
Jadcherla, Sudarshan (2016) Dysphagia in the high-risk infant: potential factors and mechanisms. Am J Clin Nutr 103:622S-8S
Jadcherla, Sudarshan R; Hasenstab, Kathryn A; Sitaram, Swetha et al. (2016) Effect of nasal noninvasive respiratory support methods on pharyngeal provocation-induced aerodigestive reflexes in infants. Am J Physiol Gastrointest Liver Physiol 310:G1006-14
Lang, Ivan M; Haworth, Steven T; Medda, Bidyut K et al. (2016) Mechanisms of airway responses to esophageal acidification in cats. J Appl Physiol (1985) 120:774-83
Lang, Ivan M (2016) The Physiology of Eructation. Dysphagia 31:121-33
Jadcherla, Sudarshan R; Shubert, Theresa R; Malkar, Manish B et al. (2015) Gestational and postnatal modulation of esophageal sphincter reflexes in human premature neonates. Pediatr Res 78:540-6
Jadcherla, Sudarshan R; Shubert, Theresa R; Gulati, Ish K et al. (2015) Upper and lower esophageal sphincter kinetics are modified during maturation: effect of pharyngeal stimulus in premature infants. Pediatr Res 77:99-106
Jadcherla, Sudarshan R; Hasenstab, Kathryn A; Shaker, Reza et al. (2015) Mechanisms of cough provocation and cough resolution in neonates with bronchopulmonary dysplasia. Pediatr Res 78:462-9
Babaei, Arash; Venu, Mukund; Naini, Sohrab Rahimi et al. (2015) Impaired upper esophageal sphincter reflexes in patients with supraesophageal reflux disease. Gastroenterology 149:1381-91
Hanin, Melissa; Nuthakki, Sushma; Malkar, Manish B et al. (2015) Safety and Efficacy of Oral Feeding in Infants with BPD on Nasal CPAP. Dysphagia 30:121-7
Madhoun, Lauren L; Siler-Wurst, Kimberly K; Sitaram, Swetha et al. (2015) Feed-Thickening Practices in NICUs in the Current Era: Variability in Prescription and Implementation Patterns. J Neonatal Nurs 21:255-262

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