Pregnancy Clinical Trial
Official title:
Classification of Fetal Breathing Patterns in the Maturing Upper Airway: Spectral Waveform Analysis of Amniotic Fluid Flow Dynamics in Normal Development, Polyhydramnios, and Oligohydramnios
Some babies have difficulty breathing, sucking, and swallowing at birth. The purpose of this
study is to determine (before birth) the variables that will predict whether a newborn will
experience these problems.
Study participants will be pregnant women with a single fetus who are 18 years or older and
who are scheduled to receive a standard prenatal ultrasound. Researchers will use the
ultrasound to observe fetal motions associated with breathing, sucking, and swallowing on
digital videotape. They will then review these tapes and take measurements that will help
them document how breathing and swallowing develop.
The aerodigestive tract is a complex system of integrated anatomical structures supporting
ingestive and respiratory functions. The developmental origins of this system begin in utero
where the prenatal growth of morphologic structures and their associated emerging behaviors
form key physiologic foundations necessary to sustain life at birth. The quality of
aerodigestive development is thus inextricably related to both the structural integrity of
its growing anatomy and the emergence of processes that promote aerodigestive functioning.
Our past research (NIH CC-00-99; NNMC #B99-089) focused specifically on emerging
oropharyngeal, and laryngeal movements of neonatal swallowing and phonation. Through
innovative sonographic techniques, this work documented ingestive development in the living
fetus; however, respiratory aspects were not explored. Intuitively, disruptions to the
fetal-maternal environment also influence respiratory development and, thus an arrest,
disorder, or delay in maturation of upper airway mechanisms may directly affect subsequent
postnatal respiratory function. Thus, the purposes of this protocol are to: 1) continue
exploration of human fetal development by elucidating the association between upper airway
growth and emerging prenatal respiratory function and, 2) determine identifiable patterns of
normal respiratory maturation that may provide indicators of postnatal airway performance.
This initiative is based on the premise that amniotic fluid volumes are influenced by the
integrity of upper airway mechanisms and thus are important for aerodigestive-related
development and fetal well being. In a collaborative effort with National Naval Medical
Center, this project will use a novel standardized 4-axis sonographic examination to quantify
growth and respiratory-related fluid flow mechanics in the upper airway of the living human
fetus. The use of this noninvasive ultrasound technique as part of the clinical prenatal
examination will not only discriminate function at four upper airway sites (perinasal, oral,
pharyngeal, and tracheal), but provide estimates of amniotic fluid flow volumes,
inspiratory-expiratory fluid flow velocities and durations, and Doppler waveform patterns
associated with fetal breathing and ingestive processes. This provides a method from which we
can begin to explore how deviations in amniotic fluid regulation may be associated with
morbidity and mortality and, the predictive utility of these indices in understanding
conditions such as oligohydramnios or polyhydramnios. This germinal database will include
healthy fetuses 16.0 to 39.6 weeks' gestational age and cases with
polyhydramnios/oligohydramnios. By elucidating how developing structures integrate with
emerging upper respiratory behaviors, this work will document the maturational events
underlying normal function at birth that in turn may facilitate future clinical strategies
for successful postnatal care.
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