Rethinking Mediterranean Diet Adherence and Body Composition: A 3-Year Prospective Observational Study in Patients with Type 2 Diabetes and Arterial Hypertension.

Chronic tube feeding dependency at discharge is a predictor of neurodevelopmental delays and cerebral palsy. The American Academy of Pediatrics recommends that infants obtain a safe feeding method before discharge from the neonatal ICU (NICU). Feeding difficulties and aerodigestive morbidities contribute to chronic tube feeding dependency among these infants that worsen neurodevelopmental outcomes while escalating socioeconomic burden. The causal and restorative mechanisms aiding improvement in the function of pharyngo-oesophageal reflexes in infants with feeding difficulties are unclear. Pharyngeal stimulation methods to improve swallowing rehabilitation in adults that lost skills have been evaluated. Currently, no such methods exist for habilitation and development of swallowing therapies for infants at risk for chronic tube feeding. Therefore, diagnostic and therapeutic approaches for facilitating tube feeding for discharge in infants are based on non-objective evidence. Hence, gastrostomy as a palliative care option is pursued. This pilot study identified biomarkers of pharyngo-oesophageal motility at the first high resolution pharyngo-oesophageal manometry (HRM) study that included stimulations, and then, longitudinally with therapeutic interventions. The interventions are novel and can be easily applicable at the point of care in the NICU. Parental biofeedback and education based on the HRM findings may be contributory to the results. Gastrostomy was averted in half of the infants at discharge, with the parental involvement increased in those infants who reached full oral feeding. Feeding and aerodigestive stimulation therapies may improve some measures of pharyngo-oesophageal motility which could be a therapeutic intervention for infants with feeding disorders.