sphs 543 january 15, 2010

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SPHS 543 January 15, 2010. Questions? Follow up: Nutritive versus non-nutritive suck Suck-swallow Breastfeeding/ breastmilk. Nutritive suck (NS) Non-nutritive suck (NNS) Sucking rhythm Sucking rate Swallowing pattern Sucking pressure. breastfeeding. Hormonally driven at first - PowerPoint PPT Presentation

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SPHS 543January 15, 2010Questions?Follow up: Nutritive versus non-nutritive suckSuck-swallowBreastfeeding/breastmilkNutritive suck (NS)Non-nutritive suck (NNS)Sucking rhythmSucking rateSwallowing patternSucking pressure

breastfeedingHormonally driven at firstLactogenesis I colostrumLactogenesis II increase in milk volume after birthMilk maintenance (supply demand)Lactogenesis III Milk removalEmpty breast = milk productionFull breast = slower milk production

Breastfeeding preemiesMilk production as part of hormones during pregnancy Midway through start making colostrumDelivery of placentaNeed to express breastmilk to produce breastmilkWeak suck, endurance, immature digestive systemNGT deliveryHerbs, medications Respiratory systemMaintain a balance of oxygen and carbon dioxide

RespirationRespiration

Biochemical definition

Ventilation

Gas transport

Respiratory system

Respiratory systemRespiratory rate

Depth of respiration

Work of breathing

Heart function

Airway maintenanceFactors affecting airwayStructural abnormalities

Neck flexion or extension

Overall postureEtiologies of respiratory failure in childrenCentral nervous systemUpper airwaysLower airwaysLung parenchymaThe PleuraeThoracic cage and surroundings

Redding et al. 1987

Airway defense mechanismapnea and infantsBelly breathersImmature ribcage Movement against gravityApnea and bradycardia in normal infantsApneic pausesHypoxia and bradycardiaMaladaptive Sucking, swallowing and breathingCoordination is essential Cessation of respiration with the swallowMean length of respiratory pause = 1 second

SSBTiming of the swallowEffect of swallowing on breathing rate and patternImpact of breathing on suckingImpact of sucking on swallowingFluid flow through nippleMaturation

ssbCompromised respiratory systemImmaturity

Assessing airway issuesStridor (videos)

Intubation

Anatomic abnormalities

Overall neurological status

Patterns of respiration

Assessing Airway IssuesHistoryStridor; Patterns of respirationAnatomic abnormalitiesNeurologic/congenital problemsInfections/Disease processesIntubation

Assessing airway issuesLevel of Obstruction

Pulmonary disease or Infection

Presence of Cough

Respiration at rest and with feeding

airway issues and treatmentObstructionNasalTongue

Mandibular hypoplasia

Tracheotomy in ChildrenAlternate pathway for respirationUpper airway obstruction, neurologic impairment, chronic pulmonary diseasePharyngeal phase most affected by trach

Airway issues and treatmentLaryngeal anomalies

Obstructive Sleep Apnea

Tracheoesophageal fistula

Congenital diaphragmatic hernia

GER

A few words about.pneumoniaCommunity acquired

Nosocomial

AspirationaspirationPenetration of secretions or any foreign particulate substances beyond the laryngeal inlet into the tracheobronchial treeThreatens lower airwaysFrequency, amount and properties of aspirateRed flagsFactors that can contribute to aspiration

Gastroesophageal refluxThe return of gastric contents, either food alone or mixed with stomach acid, into the esophagus. Reflux is normal!

Barriers to refluxLES

Growth

Saliva

Respiratory protective systems

GERGastric emptying

Pressure relationships

Respiratory impact

GER or GERD?Weight loss or inadequate weight gain (FTT)Persistent irritabilityFood refusal/selectivityPostureCoughing/chokingPainApneaSleep disturbanceRecurrent pneumonia

Causes of GERDFood allergies/intolerance

Immature digestive system

Immature neurological system

treatmentMedicationsThickening formulaPositioning

treatmentSmall, frequent feedingsFrequent burpingSurgeryPercutaneous endoscopic gastrostomy (PEG)

Short bowl (gut) syndromeMalabsorbtion and subsequent malnutrition that is induced following a massive small intestinal resectionNecrotizing enterocolitis (NEC)Intestinal malrotationGastroschisis/OmphaloceleMultiple intestinal atresias

malnutritionLoss of body composition that can be prevented or reversed by nutritional repletionMulti-factorialPrimary and secondary typesVicious cycleImmune system