Abstract
The usefulness of qualitative or quantitative volumetric magnetic resonance imaging (MRI) in early detection of brain structural changes and prediction of adverse outcomes in neonatal illnesses warrants further investigation. Our aim was to correlate certain brain injuries and the brain volume of feeding-related cortical and subcortical regions with feeding method at discharge among preterm dysphagic infants. Using a retrospective observational study design, we examined MRI data among 43 (22 male; born at 31.5 ± 0.8 week gestation) infants who went home on oral feeding or gastrostomy feeding (G-tube). MRI scans were segmented, and volumes of brainstem, cerebellum, cerebrum, basal ganglia, thalamus, and vermis were quantified, and correlations were made with discharge feeding outcomes. Chi-squared tests were used to evaluate MRI findings vs. feeding outcomes. ANCOVA was performed on the regression model to measure the association of maturity and brain volume between groups. Out of 43 infants, 44% were oral-fed and 56% were G-tube fed at hospital discharge (but not at time of the study). There was no relationship between qualitative brain lesions and feeding outcomes. Volumetric analysis revealed that cerebellum was greater (p < 0.05) in G-tube fed infants, whereas cerebrum volume was greater (p < 0.05) in oral-fed infants. Other brain regions did not show volumetric differences between groups. This study concludes that neither qualitative nor quantitative volumetric MRI findings correlate with feeding outcomes. Understanding the complexity of swallowing and feeding difficulties in infants warrants a comprehensive and in-depth functional neurological assessment.
Highlights
Contribution from several cortical and subcortical structures and various muscles and bones of the face and neck is crucially important to achieve normal feeding process [1]
Infants stay till discharge and those who fail to acquire feeding success, get a gastrostomy placed before discharge
This may result in failure to thrive and comorbidities leading to a gastrostomy tube (G-tube) placement [7, 11]
Summary
Contribution from several cortical and subcortical structures and various muscles and bones of the face and neck is crucially important to achieve normal feeding process [1]. Brainstem nuclei, and cerebellum play critical subcortical roles, while cortical involvement the frontal operculum, pre-frontal cortex, basal ganglia, thalamus, and insula are especially important in the voluntary control of deglutition. The thalamus and basal ganglia house motor neurons connecting the somatosensory cortex with the brainstem allowing for cortical input to and modulation of the swallowing processes [1, 7]. The brainstem contains the central pattern generator and nerve groups important to the swallowing function, with key components residing in the medulla and midbrain [9]. Six of the 12 cranial nerves (V, VII, IX, X, XI, and XII), emanate from the pons and medulla, are involved in various aspects of oral-, pharyngeal-, and esophageal-phases of swallowing, with functions ranging from conveying taste sensation to the control of orofacial and foregut musculature [1]
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