Postnatal maturation and growth of the neonatal oesophagus: Implications for neonatal and infants' feeding problems

Abstract

The two most important complex functions of the foregut are to facilitate feeding and to protect the airway. These foregut functions continue to advance through development, from fetus to adult. At least in the fetal life, protection of the airway may not be necessary; however, premature neonates born too soon will need to activate airway protection mechanisms. Both these complex functions are carried out by neuromuscular interactions involving afferent and efferent outflows linking the cranial nerves (trigeminal, facial, hypoglossal, glossopharyngeal and vagus) with the neurons of the myenteric plexus in the foregut musculature. The cranial nerves contribute to the afferent and efferent networks involving sensory-motor pathways and networks inter-communicate with the brain stem nuclei. In this chapter, we review recent advances concerning the postnatal maturation of neonatal human oesophageal motility. The main objectives of this chapter are to understand the (1) developmental physiology of oesophageal motility, (2) patterns of oesophageal peristalsis, and (3) functions of upper oesophageal sphincter and lower oesophageal sphincter during oesophageal bolus transit. All these functions contribute to safe swallowing and airway protection.