Pilot Study: Ultrasonic Evaluation of the Development of the Fetal Upper Aerodigestive Tract: Establishing Clinical Indicators of Deglutitive Function

The normal term infant at birth is able to suck-swallow in a coordinated manner sufficient for nutritional intake and protection of the upper airway. The integrity of this post-natal behavior is dependent on intrauterine growth and function of the orofacial, pharyngeal and laryngeal structures of the upper aerodigestive system. The integrity of these structures not only ensures functional postnatal ingestive skills, but also contributes to the prenatal development of the gastrointestinal tract, regulation of amniotic fluid and composition, and recirculation of solutes. This developing system thus has importance in both fetal and neonatal well-being. However, few biometric or biophysical data exist detailing the normal patterns of growth and development of the aerodigestive structures in the human fetus. Further, factors that contribute to abnormal fetal and neonatal deglutitive responses are not fully known. The purpose of this study is to establish the first anthropomorphic database on the development of aerodigestive structures in the fetus and, through sonographic biophysical profiles, examine the significance of fetal ingestive behaviors as predictors of postnatal feeding skills in at-risk infants. A detailed cross-sectional study of the development of the fetal upper aerodigestive tract and analysis of the progression of deglutitive skills over the course of gestation may lead to the early identification of factors contributing to neonatal swallowing dysfunction and other developmental delays. These data may provide insights into underlying intrauterine conditions associated with infant feeding difficulties. Resulting two- and three-dimensional ultrasonic data on the structural development of the upper aerodigestive system, coupled with biophysical data may be useful predictors of neonates at risk for nutritional and pulmonary sequelae. Further, sequential indices of normal swallowing-sucking skills may guide post-natal decisions for feeding "readiness" and advance the care of the premature, at-risk infant.