Abstract
Three patterns of fasting small intestinal motor activity are found with increasing gestational maturity, disorganised, foetal, and migrating complex. These patterns are associated with development of the smooth muscle cell, enteric nerves and the humoral environment.
Using constantly perfused multilumen nasojejunal catheters we have studied the development of small intestinal smooth muscle function and its control mechanisms in 12 preterm infants studied on 24 occasions between 28 and 44 weeks gestation. With increasing maturity well defined changes in motor function occur, gastric antral pressure (10-40cmH2O p<0.001), average duodenal pressure (3-15cmH2O p0.0001), propagated activity index (p<0.0001), and slow wave frequency (10.5-12.5cpm p=0.0001) all increased in a highly significant fashion. From the age of 32 weeks there was a significant increase in the presence of postprandial activity in response to enteral nutrition. This development profile was delayed in ill infants who were ventilated for RDS and received parenteral nutrition.
These data suggest that initially there is maturation of the smooth muscle followed by the development of control systems by the enteric nerves and the humoral environment. Gestation, well being, and nutritional status are determinants of motor development, and a knowledge of the pattern of development and the determinants now allows prediction of the stage of motor development reached. Such information may be useful in planning the introduction of enteral feeds.
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Bisset, W., Watt, J., Rivers, R. et al. THE ONTOGENY OF SMALL INTESTINAL MOTOR ACTIVITY. Pediatr Res 20, 692 (1986). https://doi.org/10.1203/00006450-198607000-00043
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DOI: https://doi.org/10.1203/00006450-198607000-00043