Real-time 3D ultrasound imaging of infant tongue movements during breast-feeding

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Real-Time 3D Imagingof A Baby's Tongue during Breast-Feeding
(click on 4D video above for movies; click on images below to enlarge)
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Left: X-Plane imaging with a true mid-sagittal view. The two framed images are perpendicularly across each other along the red-yellow line. The sub-mental position of the probe is indicated by a small blue circles with a letter P in each image. The yellow-framed coronal view shows the connective tissue (bright) separation (S) between the two lateral muscular (dark) areas (M) of the tongue. In the human body, the separation should normally be on the mid-sagittal plane. With the red line cutting through or very close to the separation, a true mid-sagittal view is obtained in the red frame, showing a wavy (peristaltic) upper surface (arrows) of the tongue together with the nipple (open pink arrow) during breastfeeding. The peristalsis from the reader’s right to left is dynamically displayed in the linked Video clip 1. (Ant: anterior; HP: hard palate; Inf: inferior; Lt: left; Pos: posterior; Rt: right; SP: soft palate; Sup: superior. The same abbreviations are used for the following figures and video clips).

Right: X-Plane imaging with an untrue mid-sagittal view. The yellow-framed coronal view also shows the connective tissue (bright) separation (S) between the two lateral muscular (dark) areas (M) of the tongue. However, the red cutting line is well off the mid-sagittally located separation. Therefore, the red-framed “sagittal” view is not truly mid-sagittal. Note such a view often shows an unconvincing peristaltic, or even up-and-down, motion pattern of the upper surface (arrows) of the tongue during breastfeeding (see the corresponding Video clip 2. An off-mid-sagittal view can usually be confirmed if the connective tissue (bright) separation is inconsistently visible (S?) during tongue motion cycles in the view.

ABSTRACT

Background: Whether infants use suction or peristaltic tongue movements or a combination to extract milk during breastfeeding is controversial. The aims of this pilot study were 1) to evaluate the feasibility of using 3D ultrasound scanning to visualise infant tongue movements; 2) to ascertain whether peristaltic tongue movements could be demonstrated during breastfeeding.

Methods: 15 healthy term infants (> 37 weeks gestation, birth weight > 2.5 kg), aged 2 weeks to 4 months were scanned during breastfeeding, using a real-time 3D ultrasound system, with a 7MHZ transducer placed sub-mentally.

Results: 1) The method proved feasible, with 72% of bi-plane data sets and 56% of real-time 3D data sets providing adequate coverage (>75%) of the infant tongue. 2) Peristaltic tongue movement was observed in 13 of 15 infants (83%) from real-time or reformatted truly mid-sagittal views under 3D guidance.

Conclusions: This is the first study to demonstrate the feasibility of using 3D ultrasound to visualise infant tongue movements during breastfeeding. Peristaltic infant tongue movement was present in the majority of infants when the image plane was truly mid-sagittal but was not apparent if the image was slightly off the mid-sagittal plane. This should be considered in studies investigating the relative importance of vacuum and peristalsis for milk transfer.