If there is poor coordination during swallowing of the thin-consistency liquid, the clinician presents nectar-thick barium to determine if there is any improvement. In the latter procedure, an infant is presented with thin-consistency barium, and the clinician determines whether the infant is able to swallow safely. A modified barium study procedure typically involves several options, including changing the nipple, repositioning, and the actual modification of barium. Current clinical practice at many hospitals, including our institutions, is to refer some preterm infants for assessment of coordination by means of a videofluoroscopic swallow study. However, coordinated swallowing by preterm infants is established much more slowly and may lead to a clinical diagnosis of immature swallowing due to prematurity. Typically developing term newborns are usually able to feed successfully from the breast or bottle by rapidly learning to coordinate the many anatomical structures involved in swallowing liquids. Together, the results suggest that slower-moving bolus transits may promote greater opportunity for available sensory information to be used to modulate timing of tongue–soft palate movements so that they are more effective for pumping liquids. Analysis of successive swallows indicated that tongue–soft palate coordination variability decreased with nectar-thick but not with thin-consistency barium. During swallows of nectar-thick compared to thin barium, tongue–soft palate coordination was more likely to be antiphase, bolus head pharyngeal transit time was longer, and coordination was significantly correlated with bolus head pharyngeal transit.
#Nectar thick consistency series
Sequences of coordinated tongue–soft palate movements and bolus transits during swallows of thin-consistency and nectar-thick-consistency barium were digitized, and time series data were used to calculate continuous relative phase, a measure of coordination. Tongue–soft palate coordination and bolus head pharyngeal transit were studied by means of postacquisition kinematic analysis of videofluoroscopic swallowing images of ten preterm infants referred from hospital NICUs due to poor oral feeding and suspicion of aspiration.
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