The Effect of Severe Intraventricular Hemorrhage on the Biorhythms of Feeding in Premature Infants

Ira H. Gewolb, Babatunde T. Sobowale, Frank L. Vice, Abhijit Patwardhan, Nino Solomonia, Eric W. Reynolds

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Suck-swallow rhythmicity and the integration of breathing into infant feeding are developmentally regulated. Neurological injury and breathing abnormalities can both impact feeding in preterm infants. Objective: To determine the effects of neurologic injury independent of effects of disordered breathing on feeding biorhythms in premature infants. Methods: Low-risk preterm infants (LRP), infants with Grade 3–4 Intraventricular Hemorrhage (IVH), those with bronchopulmonary dysplasia (BPD), and those with both BPD and IVH (BPD+IVH) were identified. Forty-seven infants, 32–42 weeks Postmenstrual Age (PMA) were evaluated on one or more occasions (131 studies). Of these, 39 infants (81 studies) were performed at >35 weeks PMA. Coefficient of variation (COV) (=standard deviation of the inter-event (e.g., suck-suck, swallow-breath, etc.) interval divided by the mean of the interval) was used to quantify rhythmic stability. Results: To adjust for PMA, only those infants >35–42 weeks were compared. Suck-suck COV was significantly lower (more rhythmically stable) in the LRP group [COV = 0.274 ± 0.051 (S.D.)] compared to all other groups (BPD = 0.325 ± 0.066; IVH = 0.342 ± 0.072; BPD + IVH = 0.314 ± 0.069; all p < 0.05). Similarly, suck-swallow COV was significantly lower in LRP babies (0.360 ± 0.066) compared to the BPD group (0.475 ± 0.113) and the IVH cohort (0.428 ± 0.075) (p < 0.05). The BPD+IVH group (0.424 ± 0.109), while higher, was not quite statistically significant. Conclusions: Severe IVH negatively impacts suck-suck and suck-swallow rhythms. The independent effect of neurological injury in the form of IVH on feeding rhythms suggests that quantitative analysis of feeding may reflect and predict neurological sequelae.

Original languageEnglish
Article number673152
JournalFrontiers in Pediatrics
StatePublished - Aug 23 2021

Bibliographical note

Funding Information:
This work was supported in part by NIH #5K23K05081 (ER).

Publisher Copyright:
© Copyright © 2021 Gewolb, Sobowale, Vice, Patwardhan, Solomonia and Reynolds.


  • biorhythms
  • deglutition disorders
  • infant feeding
  • intraventricular hemorrhage
  • nutritive suck
  • premature infant
  • suck
  • swallow

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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