Gewolb, I. H., Sobowale, B. T., Vice, F. L., Patwardhan, A., Solomonia, N., & Reynolds, E. W. (2021). The Effect of Severe Intraventricular Hemorrhage on the Biorhythms of Feeding in Premature Infants. Frontiers in Pediatrics, 870.

Background: Suck-swallow rhythmicity and the integration of breathing into infant feeding are developmentally regulated. Neurological injury and breathing abnormalities can both impact feeding in preterm infants.

Objective: To determine the effects of neurologic injury independent of effects of
disordered breathing on feeding biorhythms in premature infants

Conclusions: We have previously shown that the suck-swallow-breathe rhythms and patterns in preterm infants with bronchopulmonary dysplasia (BPD) differ significantly from those in low-risk
preterm infants (14–18). This has raised the question as to whether the dysrhythmias and abnormal coordination patterns noted in infants with BPD are caused by difficulty breathing
or by the often-concomitant underlying neurological injury commonly seen as co-morbid conditions (such as IVH) in medically complex preterm infants. Neonates with BPD often have IVH or other markers of neurological injury; thus, it is important to differentiate the dysrhythmic effects of neurological injury from any direct respiratory effects of BPD on infant feeding, since a specific “signature” in feeding in infants with neurological issues pointing to a more
vulnerable population would allow resources to be targeted.

Severe IVH has a negative impact on the biorhythms of suck, suck and suck-swallow in preterm infants 35–42 weeks PMA. If a preterm infant with IVH but without BPD at 35–42 weeks PMA
lacks adequate feeding biorhythms, there could be a need for additional workup to identify possibly undetected neurological injury. The independent effect of severe IVH on feeding rhythms
suggests that quantitative analysis of feeding may both reflect and predict neurological sequelae, and perhaps points to a critical period where intervention may be most efficacious.