Sleep dysfunction in social anxiety disorder.

Dysphagia (swallowing abnormalities) and delayed acquisition of independent oral feeding skills are a common barrier to discharge for infants in the neonatal intensive care unit (NICU). Dysfunction of the oral, pharyngeal, and/or esophageal phases of swallowing contribute to neonatal dysphagia [], and are frequently the sequelae of underlying diagnoses such as prematurity, chronic lung disease and neurodevelopmental delay []. Infants unable to achieve oral feeding goals often require gastrostomy tube (G-tube) placement for long-term enteral nutrition. While the timing and indication of G-tube placement varies across NICUs within the United States [], the overall rate of surgical G-tube placement in infants less than 1 year of age has increased from 96.6 to 127.3 per 100,000 from 1997 to 2009 []. This translates to a subsequent rise in healthcare costs as approximately $41,000 is required for the general care and maintenance of the G-tube over the first year []. Complication rates following placement of a surgical or percutaneous G-tube are also problematic and may be as high as 50% [–]. Additionally, many infants continue to demonstrate persistent dysphagia following G-tube placement, presenting a significant challenge to parents and providers in the development of long-term feeding strategies for these high-risk infants. The effect of chronic tube feeding and optimal strategy for post-G-tube feeding rehabilitation is unknown. To enhance interventions in dysphagic adults, studies have investigated the effects of oropharyngeal swallowing on esophageal motility and found an increase in distal esophageal amplitudes and the number of peristaltic swallows following effortful swallowing [, ]. These results may lead to additional treatment options in patients with esophageal motility disorders [, ]. Given the increasing number of infants requiring G-tube, similar studies aiming to understand the pathophysiologic adaptations of esophageal sensory-motor reflexes and potential targets for therapeutic interventions may lead to an improvement in feeding therapies. Currently, the mechanisms of persistent feeding difficulties in G-tube-fed infants is not well understood and may be secondary to pharyngo-esophageal motility. Furthermore, the role played by the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), or of the esophageal body in protecting the proximal aerodigestive tract is unclear. Therefore, our study goal was to examine the peristaltic reflexes, UES contractile reflexes (UESCR), and LES relaxation reflexes (LESRR) to characterize the pathophysiologic adaptations during longitudinal maturation. We hypothesized that maturation of esophageal and sphincteric reflexes are distinct among infants with G-tubes compared to age-matched controls without the G-tube.