1
|
Frakking TT, David M, Chang AB, Sarikwal A, Humphries S, Day S, Weir KA. Influence of frame rate in detecting oropharyngeal aspiration in paediatric videofluoroscopic swallow studies - An observational study. Eur J Radiol 2024; 170:111275. [PMID: 38142573 DOI: 10.1016/j.ejrad.2023.111275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES The videofluoroscopic swallow study (VFSS), currently the gold standard for assessing aspiration in children, incurs radiation. Adhering to the ALARA principle is crucial in minimising radiation dose whilst obtaining accurate diagnostic information in children. International adult VFSS guidelines recommend a capture rate of 30 frames per second (fps). Higher capture rates increase radiation yet there is limited evidence on best practice VFSS capture rates in children, particularly on thin fluid consistency-the fastest viscosity with the highest potential for missed aspiration on slower capture rates. We aimed to determine if image acquisition at 30fps versus 15fps alters the accuracy of detecting aspiration when assessing thin fluids during paediatric VFSS. MATERIALS & METHODS Seventeen speech language pathologists (SLPs) blindly rated a total of 2,356 swallow loops for the presence/absence of aspiration from VFSS recordings of 13 infants/children drinking thin fluids. 76 swallow loops were randomly presented at 15 versus 30fps, on two occasions. Area under receiver operating curve (aROCs) was used to compare the accuracy of aspiration ratings at 15 versus 30fps compared to a comparison set. The intraclass correlation coefficient (ICC) was used to examine rater reliability. RESULTS Accuracy for detecting aspiration was near-identical at 15fps (aROC:0.97; 95%CI:0.96-0.97) and 30fps (0.96; 95%CI 0.96-0.97). Good inter-rater (ICC:0.82; 95%CI:0.72-0.89) and intra-rater reliability among the raters (ICC:0.89; 95%CI:0.82-0.93) was found. CONCLUSION Using 15fps in paediatric VFSS when assessing thin fluid consistency aspiration provides a similar detection rate to using 30fps. As 15fps would have a lower radiation dose than 30fps, we recommend using 15fps when undertaking VFSS in children. CLINICAL RELEVANCE STATEMENT Adhering to the ALARA principles, a capture rate of 15fps should be used in paediatric VFSS for assessment on thin fluids.
Collapse
Affiliation(s)
- Thuy T Frakking
- Research Development Unit, Caboolture Hospital, Queensland Health, McKean St, Caboolture 4510, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, The University of Queensland, Herston 4101, Queensland, Australia; Speech Pathology Department, Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, Queensland, Australia; School of Health Sciences & Social Work, Griffith University, 1 Parklands Drive, Southport, Gold Coast 4222, Queensland, Australia
| | - Michael David
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Sydney, New South Wales, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast 4222, Queensland, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, 501 Stanley St, South Brisbane, 4101, Queensland, Australia; Child Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina 0811, Northern Territory, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Level 7, 62 Graham St, South Brisbane, 4101, Queensland, Australia
| | - Anubhav Sarikwal
- I-MED Radiology Network, Caboolture Hospital, McKean St, Caboolture 4510, Queensland, Australia
| | - Seiji Humphries
- Research Development Unit, Caboolture Hospital, Queensland Health, McKean St, Caboolture 4510, Queensland, Australia
| | - Sarah Day
- Speech Pathology and Audiology Department, Caboolture Hospital, Queensland Health, McKean St, Caboolture 4510, Queensland, Australia; University of Newcastle, College of Health, Medicine and Wellbeing, School of Health Sciences, University Drive, Callaghan, NSW 2308, Australia
| | - Kelly A Weir
- School of Health Sciences & Social Work, Griffith University, 1 Parklands Drive, Southport, Gold Coast 4222, Queensland, Australia; Department of Audiology & Speech Pathology, University of Melbourne, 550 Swanston St, Carlton 3053, Victoria, Australia; Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Victoria, Australia.
| |
Collapse
|
2
|
Soyer T, Arslan SS, Pişiren B, Boybeyi Ö, Yalcın E, Demir N. The Role of Bolus Residue and Its Relation with Respiratory Problems in Children with Esophageal Atresia. Dysphagia 2023; 38:1546-1550. [PMID: 37138140 DOI: 10.1007/s00455-023-10582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
Bolus residue is significant risk factor for postswallow aspiration. A retrospective study was performed to evaluate the role of bolus residue and its relation with respiratory problems in children with esophageal atresia. Children were evaluated for demographic features, type of esophageal atresia, associated anomalies, and respiratory problems. The videofluoroscopic swallowing evaluation (VFSE) was performed, and scored by using the penetration aspiration scale (PAS), bolus residual score (BRS) and normalized residual ratio scale (NRRS). Children with and without respiratory problems were also compared in terms of aspiration and bolus residue. Forty-one children with a median age of 15 months (1-138 months), male:female ratio of 26:15 was included. 65.9% (n = 27) of children were type-C and 24.4% (n = 10) were type-A EA. In 61% (n = 25) of children had liquid aspiration (PAS ≥ 6) and 9.8% (n = 4) had aspiration in pudding consistencies. Children with aspiration in liquids had significantly higher NRRS and BRS scores in vallecular residue for pudding consistencies when compared to children without aspiration (p < 0.05). No difference was detected in terms of PAS scores and bolus residual parameters between children with and without respiratory problems (p > 0.05). Children with aspiration in liquids have higher scores of BRS and NRRS at the level of vallecular especially in pudding consistencies. VFSE findings for bolus residue did not show significant relation with respiratory problems. Respiratory morbidity in children with EA is multifactorial and may not only explained by bolus residuals and aspiration.
Collapse
Affiliation(s)
- Tutku Soyer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Begüm Pişiren
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Özlem Boybeyi
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcın
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| |
Collapse
|
3
|
Canick J, McGuire D, Kilpatrick KW, Perry R, Kuchibhatla M, Juhlin E, Lee JW. Predictive Factors in Identifying Pediatric Patients at Risk of Diagnostically Limited Videofluoroscopic Swallow Studies. EAR, NOSE & THROAT JOURNAL 2023:1455613231205532. [PMID: 37881941 DOI: 10.1177/01455613231205532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Objective: Videofluoroscopic swallow studies (VFSS) are highly effective in characterizing pediatric dysphagia, but they are time- and resource-intensive, and necessitate the use of radiation. Identifying patients unlikely to benefit from VFSS is crucial to improving patient safety and resource allocation. The purpose of this study was to assess whether the ability of a patient to consume at least 0.5 oz by mouth is a reliable indicator of their ability to produce a diagnostically useful VFSS. Study Design: Retrospective chart review. Methods: Clinical data of pediatric patients aged 0 to 18 years, who underwent VFSS at a tertiary academic medical center from 2014 to 2021 were analyzed. Results: Regardless of whether due to mechanical dysphagia or oral aversion, an inability to consume at least 0.5 oz of any texture by mouth at home was not found to be associated with nondiagnostic VFSS. Age was found to have an effect on VFSS utility with toddlers having higher odds of nondiagnostic VFSS compared to children and adolescents. Overall, there was no significant interaction between the ability to take at least 0.5 oz and age group. Gastrointestinal (GI) and neuromuscular comorbidities were also associated with clinically useful swallow studies. Conclusions and Relevance: Clinicians should consider several factors, including age, at-home intake by mouth, and comorbidities such as neuromuscular and GI disorders, as they decide whether to order a VFSS.
Collapse
Affiliation(s)
- Julia Canick
- School of Medicine, Duke University Durham, NC, USA
| | - Dehra McGuire
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kayla W Kilpatrick
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Raquel Perry
- School of Medicine, Duke University Durham, NC, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Erika Juhlin
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Janet W Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
4
|
Grechi TH, Itikawa CE, Gallarreta FWM, Anselmo-Lima WT, Valera FCP, Trawitzki LVV. Effect of rapid maxillary expansion on masticatory and swallowing functions in children with posterior crossbite. Braz J Otorhinolaryngol 2023; 89:101304. [PMID: 37647736 PMCID: PMC10474078 DOI: 10.1016/j.bjorl.2023.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/24/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE Investigate the influence of posterior crossbite on masticatory and swallowing functions by videofluoroscopy examination and to analyze the effects of Rapid Maxillary Expansion (RME) on the same functions. METHODS A prospective longitudinal study was conducted on 32 children, 21 of them with posterior crossbite (10 girls and 11 boys, mean age 9.2 years, study group) and 11 children with no occlusal changes (6 girls and 5 boys, mean age 9.3 years, control group). The children were evaluated by an orthodontist for diagnosis, group characterization and occlusal treatment, by the otorhinolaryngology team for the assessment of respiratory symptoms, and by a speech therapist for videofluoroscopic evaluation of masticatory and swallowing parameters. The children with posterior crossbite were treated orthodontic ally using the Haas disjunctor for approximately six months and re-evaluated 5-months after removal of the appliance. Data were analyzed statistically by the Studentt-test for independent samples for comparison of the crossbite and control groups before and after treatment. RESULTS There was no significant difference in oral preparatory and oral transit times, nor in cycles and masticatory frequency, between the pre and post orthodontic treatment groups and the control group. CONCLUSION Rapid maxillary expansion did not influence the masticatory and swallowing variables studied by videofluoroscopy. However, the data require caution in interpretation.
Collapse
Affiliation(s)
- Tais H Grechi
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Ribeirão Preto, SP, Brazil
| | - Carla E Itikawa
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Fernanda W M Gallarreta
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Wilma T Anselmo-Lima
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Fabiana C P Valera
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil.
| | - Luciana V V Trawitzki
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| |
Collapse
|
5
|
Soyer T, Arslan SS, Boybeyi Ö, Demir N, Tanyel FC. The Role of Oral Feeding Time and Sham Feeding on Oropharyngeal Swallowing Functions in Children with Esophageal Atresia. Dysphagia 2023; 38:247-252. [PMID: 35570211 DOI: 10.1007/s00455-022-10461-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/22/2022] [Indexed: 01/28/2023]
Abstract
A retrospective study was performed to evaluate the role of oral feeding (OF) time and sham feeding (SF) on oral-pharyngeal swallowing functions in children with esophageal atresia (EA). Patients with EA were evaluated for age, sex, and types of atresia, time to start OF and surgical complications. Three to six weeks after full OF, videofluoroscopic swallowing evaluation (VFSE) was performed, and Penetration Aspiration Score (PAS, no aspiration = 1, penetration = 2-5, aspiration = 6-8), delay in swallowing reflex and residue after liquid and pudding consistency were noted. Patients were divided into three groups according to repair time; early primary repair (EPR, < 1 month of age), delayed primary repair (DPR, ≥ 1 month of age) and colonic interposition (CI). VFSE findings were compared between groups. In CI group, patients without aspiration in VFSE were encouraged to sham SF before CI. Patients with and without SF in CI group were also compared for oro-pharyngeal dysphagia (OPD). PAS scores were significantly higher in DPR (n = 13) group when compared to CI group (n = 12) in liquid swallowing (p = 0.032) and higher than EPR (n = 30) in pudding consistency (p = 0.03). Patients with CI showed significant OPD when compared to EPR (p = 0.017). Swallowing reflex delay was similar in both groups (p > 0.05). DPR group had significantly higher liquid residue at the level of vallecula (p = 0.028). The residue at other levels (oral, tongue base, pharyngeal wall and pyriform sinus) were similar in all groups in both liquid and pudding consistencies. There was no significant difference between sham-fed (n = 6) and not sham-fed (n = 6) infants in VFSE of OPD (p > 0.05). Patients with DPR without SF had significantly higher incidence of OPD and PAS scores when compared to EPR and CI. Although CI groups has the latest OF time, SF may improve oral motor abilities and cause better OF swallowing functions than patients with delayed repair.
Collapse
Affiliation(s)
- Tutku Soyer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Özlem Boybeyi
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Feridun Cahit Tanyel
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
6
|
Li L, Liu J, Liang F, Chen H, Zhan R, Zhao S, Li T, Peng Y. Altered Brain Function Activity in Patients With Dysphagia After Cerebral Infarction: A Resting-State Functional Magnetic Resonance Imaging Study. Front Neurol 2022; 13:782732. [PMID: 35911901 PMCID: PMC9329512 DOI: 10.3389/fneur.2022.782732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 05/26/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Dysphagia after cerebral infarction (DYS) has been detected in several brain regions through resting-state functional magnetic resonance imaging (rs-fMRI). In this study, we used two rs-fMRI measures to investigate the changes in brain function activity in DYS and their correlations with dysphagia severity. Method In this study, a total of 22 patients with DYS were compared with 30 patients without dysphagia (non-DYS) and matched for baseline characteristics. Then, rs-fMRI scans were performed in both groups, and regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuation (fALFF) values were calculated in both groups. The two-sample t-test was used to compare ReHo and fALFF between the groups. Pearson's correlation analysis was used to determine the correlations between the ReHo and fALFF of the abnormal brain regions and the scores of the Functional Oral Intake Scale (FOIS), the Standardized Bedside Swallowing Assessment (SSA), the Videofluoroscopic Swallowing Study (VFSS), and the Penetration-Aspiration Scale (PAS). Results Compared with the non-DYS group, the DYS group showed decreased ReHo values in the left thalamus, the left parietal lobe, and the right temporal lobe and significantly decreased fALFF values in the right middle temporal gyrus and the inferior parietal lobule. In the DYS group, the ReHo of the right temporal lobe was positively correlated with the SSA score and the PAS score (r = 0.704, p < 0.001 and r = 0.707, p < 0.001, respectively) but negatively correlated with the VFSS score (r = −0.741, p < 0.001). The ReHo of the left parietal lobe was positively correlated with SSA and PAS (r = 0.621, p = 0.002 and r = 0.682, p < 0.001, respectively) but negatively correlated with VFSS (r = −0.679, p = 0.001). Conclusion The changes in the brain function activity of these regions are related to dysphagia severity. The DYS group with high ReHo values in the right temporal and left parietal lobes had severe dysphagia.
Collapse
Affiliation(s)
- Lei Li
- Department of Nuclear Medicine, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
| | - Jiayu Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Fenxiong Liang
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
| | - Haidong Chen
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
| | - Rungen Zhan
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
| | - Shengli Zhao
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
| | - Tiao Li
- Department of Rehabilitation Medicine, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
- *Correspondence: Tiao Li
| | - Yongjun Peng
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
- Yongjun Peng
| |
Collapse
|
7
|
Miles A, Dharmarathna I, Fuller L, Jardine M, Allen J. Developing a Protocol for Quantitative Analysis of Liquid Swallowing in Children. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1244-1263. [PMID: 35302872 DOI: 10.1044/2021_ajslp-20-00337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Objective measures in videofluoroscopic swallow studies (VFSSs) can quantify swallow biomechanics. There are a wide array of validated measures studied in infants, children, and adults. There is a need for a pediatric VFSS protocol that consists of a small number of vital, time efficient, and clinically relevant measures. In this study, we aimed to establish a standard protocol for quantitative VFSS analysis in children. METHOD Protocol development began with a systematic literature review, which identified 22 quantitative and eight descriptive measures available in the literature. A pediatric VFSS database of 553 children was collected using a standardized VFSS protocol. Studies were evaluated using the 30 previously reported measures covering displacement and timing parameters as well as penetration-aspiration and residue. Measures were tested for rater reliability and internal consistency. Measures meeting acceptable values for protocol inclusion were included in the final protocol (Cronbach's alpha > .53). RESULTS Interrater and intrarater reliability of 17 measures met acceptable reliability levels. During internal consistency testing, we removed six further measures based on Cronbach's alpha levels indicating that two or more measures were equivalent in measuring the same aspect of swallow biomechanics in children. A VFSS protocol of reliable, valid, and obtainable objective quantitative (n = 6) and descriptive measures (n = 3) with separate protocols for young infants (≤ 9 months) and older children was established. CONCLUSIONS A standardized quantitative VFSS protocol for children has been developed to suit two age groups (≤ 9 and > 9 months old). Consistent VFSS administration and reporting support assessment over time and across disease groups. Future research should focus on how this information can be used by clinicians to produce individualized treatment plans for children with swallowing impairment.
Collapse
Affiliation(s)
- Anna Miles
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
| | - Isuru Dharmarathna
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Laura Fuller
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
| | - Marie Jardine
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
| | - Jacqui Allen
- Department of Surgery, The University of Auckland, New Zealand
| |
Collapse
|
8
|
Smith LS, Barkmeier-Kraemer JM. Conceptual Framework Behind the Development of a Level of Confidence Tool: The Pediatric Videofluoroscopic Swallow Study Value Scale. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:689-704. [PMID: 35201847 DOI: 10.1044/2021_ajslp-20-00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The videofluoroscopic swallow study (VFSS) is the most commonly used instrumental procedure for evaluating swallowing in pediatric populations suspected of having dysphagia. Assessment and interpretation of a VFSS in pediatric populations is frequently challenged by testing-specific factors that can raise concerns regarding the representativeness of swallow events observed during testing compared to daily feeding/swallowing physiology. When VFSS findings do not represent typical swallowing patterns, treatment recommendations can result in suboptimal outcomes. To address this current challenge to pediatric VFSS interpretation and associated treatment recommendations, the pediatric VFSS Value Scale (pVFSS Value Scale) was developed within a tertiary regional pediatric medical center. This clinical focus article summarizes the initial scale development phases and resulting conceptual framework for rating clinical testing factors that influence a clinician's level of confidence regarding pediatric VFSS findings. Future goals for scientific evaluation and clinical utilization of this new rating scale are also reported. CONCLUSIONS The pVFSS Value Scale was developed to assist clinicians with interpretation of pediatric VFSS assessment outcomes and to efficiently communicate factors influencing impressions and treatment recommendations with team members and caregivers. This clinical concept article summarizes potential uses of this tool to inform treatment planning as well as future clinical research to evaluate its psychometrics and clinical utility.
Collapse
Affiliation(s)
- Leann Schow Smith
- Department of Rehabilitation, Primary Children's Hospital, Salt Lake City, UT
| | | |
Collapse
|
9
|
Pettigrew J, Tzannes G, Swift L, Docking K, Osland K, Cheng AT. Surgically Acquired Vocal Cord Palsy in Infants and Children with Congenital Heart Disease (CHD): Description of Feeding Outcomes. Dysphagia 2022; 37:1288-1304. [PMID: 34981253 DOI: 10.1007/s00455-021-10390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/22/2021] [Indexed: 11/28/2022]
Abstract
Impaired swallowing in infants can impact upon the ability to feed orally, often resulting in dependency on supplementary feeding. Such difficulties can lead to an increased burden of care and associated costs. The primary aim of this study was to investigate the impact of vocal cord palsy (VCP), acquired intraoperatively during cardiac surgery, on the feeding outcomes of infants at a tertiary metropolitan children's hospital. An additional aim was to obtain preliminary information on the impact of feeding difficulties in this group on the quality of life of parents and families. A review of 48 patients who had been referred to the speech pathology service was undertaken. Participants presented with heterogeneous cardiac diagnoses, and had an initial Videofluoroscopic Swallow Study (VFSS) at a median corrected age of 3.6 weeks. Sixty percent of participants presented with silent aspiration on VFSS. Thirty percent of participants required supplementary tube feeding more than 6 months post-surgery. Six percent of participants with poor feeding progress and persistent aspiration required further surgical intervention to support nutrition. Findings revealed no significant relationship between participant factors and the presence of feeding difficulties, however, infants with concomitant genetic and syndromic conditions were found to be most at-risk for long-term feeding difficulties. Analysis of informal parent questionnaire responses indicated parents experienced stress and anxiety after their child's discharge. This was noted in regard to their child's feeding, which impacts quality of life across a number of domains. Findings of this study highlight the importance of communicating the potential feeding difficulties to parents of at-risk infants prior to cardiac surgery. This study further highlighted the importance of routine post-operative otorhinolaryngology examinations following high-risk surgeries, as well as speech pathology management for all infants and children identified with VCP. Post-operative input from appropriately trained Speech Pathologists is vital in assisting parents to support and mitigate their child's difficulties through the provision of early intervention for feeding difficulties.
Collapse
Affiliation(s)
- Jane Pettigrew
- Speech Pathology Department, The Sydney Children's Hospital Network, Westmead Campus, Cnr Hawkesbury Road and Hainsworth St, Westmead, NSW, 2145, Australia.
| | - Gloria Tzannes
- Speech Pathology Department, The Sydney Children's Hospital Network, Westmead Campus, Cnr Hawkesbury Road and Hainsworth St, Westmead, NSW, 2145, Australia
| | - Laura Swift
- Speech Pathology Department, The Sydney Children's Hospital Network, Westmead Campus, Cnr Hawkesbury Road and Hainsworth St, Westmead, NSW, 2145, Australia
| | - Kimberley Docking
- NeuroKids Communication Research Laboratory, Faculty Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Kate Osland
- Speech Pathology Department, The Sydney Children's Hospital Network, Westmead Campus, Cnr Hawkesbury Road and Hainsworth St, Westmead, NSW, 2145, Australia
| | - Alan T Cheng
- ENT Department, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Westmead Campus, Cnr Hawkesbury Road and Hainsworth St, Westmead, NSW, 2145, Australia
| |
Collapse
|
10
|
Elsedawi BF, Samson N, Nadeau C, Vanhaverbeke K, Nguyen N, Alain C, Fortin-Pellerin E, Praud JP. Safety of Bottle-Feeding Under Nasal Respiratory Support in Preterm Lambs With and Without Tachypnoea. Front Physiol 2022; 12:785086. [PMID: 35046837 PMCID: PMC8762202 DOI: 10.3389/fphys.2021.785086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022] Open
Abstract
Aim: Convalescing preterm infants often require non-invasive respiratory support, such as nasal continuous positive airway pressure or high-flow nasal cannulas. One challenging milestone for preterm infants is achieving full oral feeding. Some teams fear nasal respiratory support might disrupt sucking–swallowing–breathing coordination and induce severe cardiorespiratory events. The main objective of this study was to assess the safety of oral feeding of preterm lambs on nasal respiratory support, with or without tachypnoea. Methods: Sucking, swallowing and breathing functions, as well as electrocardiogram, oxygen haemoglobin saturation, arterial blood gases and videofluoroscopic swallowing study were recorded in 15 preterm lambs during bottle-feeding. Four randomly ordered conditions were studied: control, nasal continuous positive airway pressure (6 cmH2O), high-flow nasal cannulas (7 L•min–1), and high-flow nasal cannulas at 7 L•min–1 at a tracheal pressure of 6 cmH2O. The recordings were repeated on days 7–8 and 13–14 to assess the effect of maturation. Results: None of the respiratory support impaired the safety or efficiency of oral feeding, even with tachypnoea. No respiratory support systematically impacted sucking–swallowing–breathing coordination, with or without tachypnoea. No effect of maturation was found. Conclusion: This translational physiology study, uniquely conducted in a relevant animal model of preterm infant with respiratory impairment, shows that nasal respiratory support does not impact the safety or efficiency of bottle-feeding or sucking–swallowing–breathing coordination. These results suggest that clinical studies on bottle-feeding in preterm infants under nasal continuous positive airway pressure and/or high-flow nasal cannulas can be safely undertaken.
Collapse
Affiliation(s)
- Basma Fathi Elsedawi
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
- Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nathalie Samson
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Charlène Nadeau
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Kristien Vanhaverbeke
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
- Laboratory of Experimental Medicine and Pediatrics, Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Nam Nguyen
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
- Faculty of Human Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Charles Alain
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Etienne Fortin-Pellerin
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Paul Praud
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
- *Correspondence: Jean-Paul Praud,
| |
Collapse
|
11
|
Christovam CA, Manica D, Schweiger C, Sekine L, Miranda PP, Levy DS. Instrumental Swallowing Assessments in the Neonatal and Pediatric Populations: A Systematic Review. Dysphagia 2021; 37:1183-1200. [PMID: 34719729 DOI: 10.1007/s00455-021-10379-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
The scientific scope of swallowing disorders in the neonatal and pediatric populations is growing exponentially; however, the preponderance of evidence for evaluation protocols has been concentrated in non-instrumental evaluations creating a lack of research about protocols for instrumental swallowing assessment. Thus, the purpose of this study was to systematically review the literature to identify and to report protocols used in instrumental assessments through videofluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) in the neonatal and pediatric populations to support clinical decision making. The search strategy was applied in five online databases, no filters were applied to restrict languages or publication dates and the gray literature was reviewed. PRISMA statement was used to guide the construction of this review. The studies included validated and unvalidated protocols, the validated protocols had their risk of bias estimated using the QUADAS-2. In total, 13 studies were included in the final review, of these eleven assessed through QUADAS-2, and two classified with low risk of bias. One study is in the process of standardization and validation of an instrumental assessment protocol for swallowing in bottle-fed infants through VFSS. Information about validity and reliability of published protocols for instrumental evaluation in the neonatal and pediatric populations is limited. Therefore, further research is needs to development studies aiming to standardize and validate protocols for instrumental assessments in these populations.
Collapse
Affiliation(s)
- Caroline Aguirre Christovam
- Multiprofessional Resident in the Critical Patient Care Program at Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
| | - Denise Manica
- Otolaryngology/Head and Neck Surgery Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Claudia Schweiger
- Otolaryngology/Head and Neck Surgery Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Programa de Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Leo Sekine
- Faculdade de Medicina, Universidade Federal do Rio Grando do Sul, Porto Alegre, RS, Brazil
| | - Priscilla Poliseni Miranda
- Programa de Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Deborah S Levy
- Department of Speech, Language and Audiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
- Department of Health and Communication, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil.
| |
Collapse
|
12
|
Clinical and videofluoroscopic evaluation of feeding and swallowing in infants with oropharyngeal dysphagia. Int J Pediatr Otorhinolaryngol 2021; 150:110900. [PMID: 34461381 DOI: 10.1016/j.ijporl.2021.110900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/15/2021] [Accepted: 08/22/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Dysphagia impacts infants' health and well-being and may result in aspiration pneumonia. OBJECTIVE This study aimed to evaluate feeding and swallowing functions in infants with dysphagia to determine the possible causes of dysphagia and their relationship with the medical diagnoses. Clinical and videofluoroscopic findings were compared to determine the diagnostic accuracy of clinical evaluation and identify clinical predictors of laryngeal penetration and aspiration. METHODS This study was conducted on 60 infants in the age range 2-19 months (median seven months) with suspected aspiration and/or feeding problems. All cases were subjected to both clinical and videofluoroscopic evaluation of swallowing. RESULTS The two most frequently observed videofluoroscopic findings were aspiration and suck-swallow-breathing incoordination. Infants with structural laryngeal abnormalities were significantly more likely to experience aspiration. A significant association was found between the presence of aspiration and the presence of both recurrent chest infection and gurgly voice combined, which increased the risk of aspiration by 3.57 times. However, the presence of gagging alone and gagging combined with a recurrent chest infection significantly reduced the risk of aspiration. The clinical assessment accuracy presented 56.70%, with 55.60% sensitivity, 58.30% specificity, and a positive predictive value higher than the negative. CONCLUSION The study highlights the importance of complementing clinical evaluation, in infants with dysphagia, with an objective evaluation of swallowing such as videofluoroscopy due to the high proportion of false positives noticed in clinical evaluation and the high prevalence of silent aspiration in infants.
Collapse
|
13
|
Jadcherla SR, Hasenstab KA, Osborn EK, Levy DS, Ipek H, Helmick R, Sultana Z, Logue N, Yildiz VO, Blosser H, Shah SH, Wei L. Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study. Sci Rep 2021; 11:19934. [PMID: 34620898 PMCID: PMC8497609 DOI: 10.1038/s41598-021-99070-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/20/2021] [Indexed: 02/08/2023] Open
Abstract
Videofluoroscopy swallow studies (VFSS) and high-resolution manometry (HRM) methods complement to ascertain mechanisms of infant feeding difficulties. We hypothesized that: (a) an integrated approach (study: parent-preferred feeding therapy based on VFSS and HRM) is superior to the standard-of-care (control: provider-prescribed feeding therapy based on VFSS), and (b) motility characteristics are distinct in infants with penetration or aspiration defined as penetration-aspiration scale (PAS) score ≥ 2. Feeding therapies were nipple flow, fluid thickness, or no modification. Clinical outcomes were oral-feeding success (primary), length of hospital stay and growth velocity. Basal and adaptive HRM motility characteristics were analyzed for study infants. Oral feeding success was 85% [76-94%] in study (N = 60) vs. 63% [50-77%] in control (N = 49), p = 0.008. Hospital-stay and growth velocity did not differ between approaches or PAS ≥ 2 (all P > 0.05). In study infants with PAS ≥ 2, motility metrics differed for increased deglutition apnea during interphase (p = 0.02), symptoms with pharyngeal stimulation (p = 0.02) and decreased distal esophageal contractility (p = 0.004) with barium. In conclusion, an integrated approach with parent-preferred therapy based on mechanistic understanding of VFSS and HRM metrics improves oral feeding outcomes despite the evidence of penetration or aspiration. Implementation of new knowledge of physiology of swallowing and airway protection may be contributory to our findings.
Collapse
Affiliation(s)
- Sudarshan R. Jadcherla
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Division of Neonatology, Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH 43215 USA ,grid.412332.50000 0001 1545 0811Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Kathryn A. Hasenstab
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Erika K. Osborn
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Division of Neonatology, Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Deborah S. Levy
- grid.8532.c0000 0001 2200 7498Department of Speech and Language Pathology, Hospital de Clínicas de Porto Alegre, Department of Health and Communication, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Haluk Ipek
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Roseanna Helmick
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Zakia Sultana
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Nicole Logue
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Division of Neonatology, Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Vedat O. Yildiz
- grid.240344.50000 0004 0392 3476Biostatistics Resource at Nationwide Children’s Hospital (BRANCH), Nationwide Children’s Hospital, Columbus, OH USA ,grid.261331.40000 0001 2285 7943Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH USA
| | - Hailey Blosser
- grid.240344.50000 0004 0392 3476Division of Clinical Therapies, Nationwide Children’s Hospital, Columbus, OH USA
| | - Summit H. Shah
- grid.240344.50000 0004 0392 3476Department of Radiology, Nationwide Children’s Hospital, Columbus, OH USA
| | - Lai Wei
- grid.261331.40000 0001 2285 7943Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH USA
| |
Collapse
|
14
|
Balest AL, Mahoney AS, Shaffer AD, White KE, Theiss R, Dohar J. Infant aspiration and associated signs on clinical feeding evaluation. Int J Pediatr Otorhinolaryngol 2021; 149:110856. [PMID: 34358815 DOI: 10.1016/j.ijporl.2021.110856] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Few studies have examined clinical signs of aspiration in infants <51 weeks post-menstrual age (PMA) for whom the laryngeal cough reflex is not fully developed. This retrospective study explored 1) the association between signs of aspiration on a clinical feeding evaluation (CFE) and/or comorbid conditions with aspiration (silent or overt) on a modified barium swallow study (MBS) for infants in this age range, 2) the association between lower respiratory infection (LRI) and aspiration on MBS, and 3) the sensitivity and specificity of detecting aspiration according to signs on CFE and the evaluating speech-language pathologist's (SLP) years of experience. METHODS A retrospective review of charts of patients with MBS completed January 1, 2012-December 31, 2014 was performed. Patients were included if they were <51-weeks PMA at the time of MBS and had a CFE conducted no more than seven days prior to the MBS. Patient age, comorbidities, and MBS and CFE details were collected. The impact of CFE findings, patient age, comorbid syndromes/associations, and aerodigestive diagnoses on the odds of demonstrating silent aspiration (SA) or overt aspiration during MBS with thin liquids was determined using logistic regression, and the sensitivity and specificity of CFE for identifying SA was calculated. RESULTS Results from 114 patients indicated that 46 (40 %) of the infants had SA and nine (8 %) had overt aspiration on MBS. Notable signs on CFEs were cough (36 %), oxygen desaturations (33 %), and chest congestion (32 %). On multiple regression analysis there was increased odds of SA on MBS with at least one clinical sign on CFE (OR: 24.3, p = 0.02), chronic lung disease, (OR: 18.2, p = 0.01), and airway abnormalities (OR: 2.94, p = 0.01). Cough on CFE was associated with increased odds of overt aspiration on MBS (OR: 5.69, p = 0.04). Neither SA nor overt aspiration were significantly associated with LRI. Sensitivity and specificity of CFE for correctly identifying the presence of SA were 98 % and 15 %, respectively; experience of the SLP was not a contributing factor. CONCLUSION Further study is required to determine if specific signs on CFE are predictive of aspiration.
Collapse
Affiliation(s)
- Arcangela L Balest
- UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, Division of Neonatology, USA.
| | - Amanda S Mahoney
- University of Pittsburgh Communication Science and Disorders, 3600 Atwood Street, Forbes Tower, Pittsburgh, PA, 15260, USA
| | - Amber D Shaffer
- UPMC Children's Hospital of Pittsburgh, Department of Otolaryngology, USA
| | - Katherine E White
- UPMC Children's Hospital of Pittsburgh, Department of Audiology and Communication Disorders, USA
| | - Robert Theiss
- University of Pittsburgh, School of Medicine, Present Address Allegheny General Hospital, Pittsburgh, PA, USA
| | - Joseph Dohar
- University of Pittsburgh Communication Science and Disorders, 3600 Atwood Street, Forbes Tower, Pittsburgh, PA, 15260, USA; UPMC Children's Hospital of Pittsburgh, Department of Otolaryngology, USA
| |
Collapse
|
15
|
Alain C, Samson N, Nadeau C, Beaudoin JF, Lienhart C, Counil C, Praud JP. Nasal respiratory support and tachypnea and oral feeding in full-term newborn lambs. J Appl Physiol (1985) 2021; 130:1436-1447. [PMID: 33661723 DOI: 10.1152/japplphysiol.00567.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Newborn infants with respiratory difficulties frequently require nasal respiratory support such as nasal continuous positive airway pressure (nCPAP) or high-flow nasal cannulae (HFNC). Oral feeding of these infants under nasal respiratory support remains controversial out of fear of aspiration and cardiorespiratory events. The main objective of this study was to evaluate the safety of oral feeding under different types of nasal respiratory support in newborn lambs without or with tachypnea. Eight lambs aged 4-5 days were instrumented to record sucking, swallowing, respiration, ECG, oxygen saturation, and arterial blood gases. Each lamb was given two bottles of 30 mL of milk with a pause of 30 s under videofluoroscopy in four conditions [no respiratory support, nCPAP 6 cmH2O, HFNC 7 L/min, HFNCCPAP (= HFNC 7 L/min + CPAP 6 cmH2O)] administered in random order. The study was conducted in random order over 2 days, with or without standardized tachypnea induced by thoracic compression with a blood pressure cuff. Generalized linear mixed models were used to compare the four nasal respiratory supports in terms of safety (cardiorespiratory events and aspiration), sucking-swallowing-breathing coordination, and efficacy of oral feeding. Results reveal that no nasal respiratory support impaired the safety of oral feeding. Most of the few laryngeal penetrations we observed occurred with HFNCCPAP. Nasal CPAP modified sucking-swallowing-breathing coordination, whereas the efficiency of oral feeding decreased under HFNCCPAP. Results were similar with or without tachypnea. In conclusion, oral feeding under nasal respiratory support is generally safe in a term lamb, even with tachypnea.NEW & NOTEWORTHY The practice of orally feeding newborns suffering from respiratory problems while on nCPAP or HFNC remains controversial for fear of triggering cardiorespiratory events or aspiration pneumonia, or aggravating chronic lung disease. The present results show that bottle-feeding is generally safe in full-term lambs under nasal respiratory support, both without and with tachypnea.
Collapse
Affiliation(s)
- Charles Alain
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nathalie Samson
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Charlène Nadeau
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean-François Beaudoin
- Centre d'imagerie moléculaire de Sherbrooke (CIMS), Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Camille Lienhart
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Clément Counil
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean-Paul Praud
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| |
Collapse
|
16
|
Dodrill P. Evaluating Feeding and Swallowing in Infants and Children. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
17
|
Etges CL, Barbosa LDR, Cardoso MCDAF. Development of the Pediatric Dysphagia Risk Screening Instrument (PDRSI). Codas 2020; 32:e20190061. [PMID: 33053082 DOI: 10.1590/2317-1782/20202019061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/28/2019] [Indexed: 01/30/2023] Open
Abstract
OBJETIVO Desenvolver um instrumento de rastreio para a identificação de crianças com risco para disfagia, em ambiente hospitalar. MÉTODO O Instrumento de Rastreio para o Risco de Disfagia Pediátrica (IRRD-Ped), constituído por 23 questões, foi desenvolvido por fonoaudiólogos, após revisão da literatura. Ele foi proposto para ser aplicado aos responsáveis por crianças em internação hospitalar. O IRRD-Ped foi enviado a juízes para análise, tendo sido também realizado um estudo piloto. Para verificar a validade de critério, aplicou-se o IRRD-Ped aos responsáveis por crianças internadas e, posteriormente, realizou-se, com estas crianças, avaliação clínica da deglutição, através do Protocolo de Avaliação da Disfagia Pediátrica (PAD-PED). Os responsáveis assinaram o Termo de Consentimento Livre e Esclarecido. Os sujeitos foram separados em dois grupos (com disfagia e com deglutição normal), sendo verificada a associação entre as questões do IRRD-Ped e o resultado do PAD-PED, através do teste qui-quadrado de Person ou exato de Fisher. Definiu-se o ponto de corte para presença de risco para disfagia através da Curva ROC. A confiabilidade do IRRD-Ped foi verificada pelo coeficiente α de Cronbach. RESULTADOS A amostra foi constituída por 40 crianças com mediana de idade de 3,7 meses. Verificou-se associação estatisticamente significativa em oito itens do instrumento. A consistência interna do IRRD-Ped foi de 0,828. O ponto de corte para o risco de disfagia foi de cinco pontos (sensibilidade = 100% e especificidade = 80%). CONCLUSÃO Devido aos satisfatórios resultados encontrados, deve-se dar prosseguimento ao processo de validação do IRRD-Ped.
Collapse
Affiliation(s)
- Camila Lucia Etges
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
| | - Lisiane De Rosa Barbosa
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
| | | |
Collapse
|
18
|
Pavithran J, Puthiyottil IV, Kumar M, Nikitha AV, Vidyadharan S, Bhaskaran R, Chandrababu Jaya A, Thankappan K, Subramania I, Sundaram KR. Exploring the utility of fibreoptic endoscopic evaluation of swallowing in young children- A comparison with videofluoroscopy. Int J Pediatr Otorhinolaryngol 2020; 138:110339. [PMID: 32911239 DOI: 10.1016/j.ijporl.2020.110339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS In adults, fibreoptic endoscopic evaluation of swallowing (FEES) has established its place in the assessment of dysphagia and aspiration vis-à-vis the current gold standard, videofluoroscopic swallow study (VFSS), almost at parity. However, in children with quite a different set of factors in play, its role is not certain. The primary objective was to measure the accuracy of FEES in young children with dysphagia, compared to VFSS. The secondary objective was to correlate other endoscopic findings with aspiration in videofluoroscopy. STUDY DESIGN Prospective, observational. METHODOLOGY Sixty-five children, aged 0.4-36 months with suspected oropharyngeal dysphagia and aspiration underwent FEES and VFSS. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and diagnostic agreement of FEES were calculated using VFSS as the gold standard. To test the statistical significance of the difference in two measurements, Mc Nemar's Chi-square test was used and to test the agreement between FEES and VFSS, Kappa value was calculated. To test the statistical significance of the association of endoscopic findings with VFSS findings, Chi-square test was used. RESULTS FEES performed in young children was found to be less sensitive (50%) but more specific of aspiration (82%) with an accuracy of 77% in comparison with VFSS. The reverse was true of penetration (81%, 44% and 59% respectively). The agreement between FEES and VFSS in young children, on all parameters were low (k = 0.061-0.302). Endoscopic findings such as glottic secretions (P = 0.02), weak or diminished laryngeal adductor reflex (LAR) (P = 0.001) and penetration (P = 0.01) were significantly associated with aspiration in VFSS. Excessive secretions in the hypopharynx had a stronger correlation with oesophageal dysmotility (P = 0.02) than pharyngeal dysphagia (P = 0.05). CONCLUSION FEES in young children appears to have a low agreement with VFSS unlike in adults. Aspiration observed in FEES is likely to be significant since specificity is high. FEES negative for aspiration may be interpreted taking into account, the aspiration risk of the subject and/or other endoscopic risk factors (penetration, weak/absent LAR & glottic secretions), if VFSS is not a viable alternative.
Collapse
Affiliation(s)
- Jayanthy Pavithran
- Department of ENT, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Indu Vadakke Puthiyottil
- Department of ENT, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Madhumita Kumar
- Department of ENT, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Anju Viswambharan Nikitha
- Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Sivakumar Vidyadharan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Renjitha Bhaskaran
- Department of Biostatistics, Amrita School of Medicine, Kochi, Kerala, India.
| | - Arya Chandrababu Jaya
- Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Iyer Subramania
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - K R Sundaram
- Department of Biostatistics, Amrita School of Medicine, Kochi, Kerala, India.
| |
Collapse
|
19
|
Weinstock MS, McCoy JL, Cangilla K, Shaffer AD, Maguire RC, Tobey ABJ, Simons JP, Padia RK. Predictive Utility of the Penetration-Aspiration Scale in Inter-Arytenoid Injection Augmentation. Laryngoscope 2020; 131:E1707-E1713. [PMID: 33009827 DOI: 10.1002/lary.29142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the utility of preoperative penetration-aspiration scale (PAS) scores and clinical findings on modified barium swallow (MBS) in predicting advancement of diet after interarytenoid injection augmentation (IAIA). STUDY DESIGN Retrospective review. METHODS In this retrospective cohort study, 372 consecutive patients who underwent IAIA for pharyngeal dysphagia between 2009 and 2019 were initially identified. Patients were excluded from the study if they had insufficient preop MBS, no postop MBS within 3 months of injection, supraglottoplasty, or underlying neurological condition. Ninety-three patients were included in the study. Pre- and postoperative PAS scores were recorded, as were pre and postop diets. PAS scores were calculated by a single pediatric speech and language pathologist. RESULTS Average PAS score on MBS was 5.87 (standard deviation [SD] 2.74); median (range) = 8 (1-8). Postop average was 4.29 (SD 3.02); median (range) = 2 (1-8), P < .001. Those with worse preop PAS scores had increased odds of improvement in diet (odds ratio 1.24, 95% confidence interval [CI] 1.02-1.49, P = .029). An improvement in PAS score of 3.0 or greater predicted an improvement in diet with a sensitivity of 76.7% and a specificity of 85.7%. CONCLUSIONS PAS score on MBS can be a useful tool when assessing pediatric patients who may be candidates for IAIA. Prospectively comparing PAS score in patients post-IAIA to patients solely undergoing diet modification can help to better objectively assess differences in outcomes and understand the full utility of PAS score. LEVEL OF EVIDENCE Level III (Individual Cohort Study) Laryngoscope, 131:E1707-E1713, 2021.
Collapse
Affiliation(s)
- Michael S Weinstock
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Jennifer L McCoy
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Kristin Cangilla
- Department of Speech and Language Pathology, Feeding and Swallowing Center, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Amber D Shaffer
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Raymond C Maguire
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Allison B J Tobey
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Jeffrey P Simons
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Reema K Padia
- Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| |
Collapse
|
20
|
Martin-Harris B, Canon CL, Bonilha HS, Murray J, Davidson K, Lefton-Greif MA. Best Practices in Modified Barium Swallow Studies. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1078-1093. [PMID: 32650657 PMCID: PMC7844340 DOI: 10.1044/2020_ajslp-19-00189] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/01/2020] [Accepted: 04/11/2020] [Indexed: 05/22/2023]
Abstract
Purpose The modified barium swallow study (MBSS) is a widely used videofluoroscopic evaluation of the functional anatomy and physiology of swallowing that permits visualization of bolus flow throughout the upper aerodigestive tract in real time. The information gained from the examination is critical for identifying and distinguishing the type and severity of swallowing impairment, determining the safety of oral intake, testing the effect of evidence-based frontline interventions, and formulating oral intake recommendations and treatment planning. The goal of this review article is to provide the state of the science and best practices related to MBSS. Method State of the science and best practices for MBSS are reviewed from the perspectives of speech-language pathologists (SLPs) and radiologists who clinically practice and conduct research in this area. Current quandaries and emerging clinical and research trends are also considered. Results This document provides an overview of the MBSS and standards for conducting, interpreting, and reporting the exam; the SLPs' and radiologist's perspectives on standardization of the exam; radiation exposure; technical parameters for recording and reviewing the exam; the importance of an interdisciplinary approach with engaged radiologists and SLPs; and special considerations for examinations in children. Conclusions The MBSS is the primary swallowing examination that permits visualization of bolus flow and swallowing movement throughout the upper aerodigestive tract in real time. The clinical validity of the study has been established when conducted using reproducible and validated protocols and metrics applied according to best practices to provide accurate and reliable information necessary to direct treatment planning and limit radiation exposure. Standards and quandaries discussed in this review article, as well as references, provide a basis for understanding the current best practices for MBSS.
Collapse
Affiliation(s)
- Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Cheri L. Canon
- Department of Radiology, The University of Alabama at Birmingham School of Medicine
| | - Heather Shaw Bonilha
- Department of Health Science and Research, Medical University of South Carolina, Charleston
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Joseph Murray
- Audiology and Speech-Language Pathology Service, VA Ann Arbor Healthcare System, MI
| | - Kate Davidson
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Maureen A. Lefton-Greif
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
21
|
Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, LeBonheur Children's Hospital, and St. Jude Children's Research Hospital, Memphis, TN
| |
Collapse
|
22
|
Hong JY, Hwang NK, Lee G, Park JS, Jung YJ. Radiation Safety in Videofluoroscopic Swallowing Study: Systematic Review. Dysphagia 2020; 36:73-82. [PMID: 32279120 DOI: 10.1007/s00455-020-10112-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/01/2020] [Indexed: 01/01/2023]
Abstract
Videofluoroscopic swallowing study (VFSS) is generally used to diagnose dysphagia and oropharyngeal aspiration during swallowing movement. Patients and bolus-feeding operators (such as occupational therapist and speech language pathologist) may undergo multiple VFSS procedure, placing them at risk for more radiation exposure due to increased scan time. The present study investigated the dose-area product, effective dose of various protocols, and summarized dose reports from various studies of VFSS. The PubMed database searched for relevant publications reporting radiation dose in the VFSS procedure. 13 articles were selected to be reviewed. This systematic review involved 13 peer-reviewed articles that reported the specific dose of the VFSS procedure. The articles were categorized into three types: operator radiation dose, adult patient radiation dose, and pediatric radiation dose. The operator dose reports showed that the operators' scattering exposure, equivalent dose (across the whole body, eyes, and hands), and annual effective dose were significantly lower than the annual dose limit of 20 mSv. Both adult and pediatric patient dose reports showed that the effective dose, which was estimated from recorded dose-area product, was significantly lower than the annual background exposure of 2.4 mSv in various protocols. The present literature review suggested that the radiation dose of VFSS by modified barium swallowing is acceptable in both operators and patients. However, various radiation protection strategies should be conducted during the procedure to reduce the risk of stochastic effect.
Collapse
Affiliation(s)
- Jun-Yong Hong
- Department of Multidisplinary Radiological Science, Graduate School, DongSeo University, 47 Jurye-ro, Sasang-gu, Busan, 47011, Republic of Korea
| | - Na-Kyoung Hwang
- Department of Occupational Therapy, Seoul North Municipal Hospital, Seoul, Republic of Korea
| | - Gihyoun Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ji-Su Park
- Advanced Human Resource Development Project Group for Health Care in Aging Friendly Industry, Dongseo University, 47 Jurye-ro, Sasang-gu, Busan, 47011, Republic of Korea.
| | - Young-Jin Jung
- Department of Multidisplinary Radiological Science, Graduate School, DongSeo University, 47 Jurye-ro, Sasang-gu, Busan, 47011, Republic of Korea. .,Advanced Human Resource Development Project Group for Health Care in Aging Friendly Industry, Dongseo University, 47 Jurye-ro, Sasang-gu, Busan, 47011, Republic of Korea. .,Department of Radiological Science at Health Sciences Division in DongSeo University, 47 Jurye-ro, Sasang-gu, Busan, 47011, Republic of Korea.
| |
Collapse
|
23
|
Martin-Harris B, Carson KA, Pinto JM, Lefton-Greif MA. BaByVFSSImP © A Novel Measurement Tool for Videofluoroscopic Assessment of Swallowing Impairment in Bottle-Fed Babies: Establishing a Standard. Dysphagia 2020; 35:90-98. [PMID: 30955137 PMCID: PMC6778717 DOI: 10.1007/s00455-019-10008-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
AIM This investigation tested the construct validity of the first standardized assessment tool, the BaByVFSS Impairment Profile, (BaByVFSSImP©), developed for the quantification of swallowing observations made from videofluoroscopic swallow studies (VFSS) in bottle-fed babies. METHOD Construct validity of the measures was tested using descriptive methods and confirmatory factor analysis (CFA) of swallowing scores obtained from a cohort of bottle-fed babies (median age 3 months 1 day, interquartile range 1 month 4 days-7 months 4 days) sequentially referred for VFSS based on clinical signs, symptoms, or risk factors associated with dysphagia and/or aspiration. Main outcome measures were emergence of functional domains derived from swallowing component impairment scores. RESULTS Confirmatory factor analysis resulted in 21 significant components (factor loadings ≥ 0.5) grouping into five functional domains labeled for common contribution to overall swallowing function. The tool was organized into the BaByVFSSImP. Clinical relevance was explored using correlational analyses between domain scores, maximum penetration/aspiration scores, feeding status, and caregiver burden. INTERPRETATION Quantification of physiologic swallowing impairment captured by BaByVFSSImP holds promise for identification of physiologically based targets for intervention, clinical decisions regarding enteral feeding, and tracking the trajectory of swallowing impairment throughout development in young children.
Collapse
Affiliation(s)
- Bonnie Martin-Harris
- Department of Communication Sciences and Disorders, Department of Otolaryngology Head and Neck Surgery, Department of Radiation Oncology, School of Communication, Feinberg School of Medicine, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA.
- Department of Otolaryngology Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, College of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
- Research Service, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL, 60141, USA.
| | - Kathryn A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 East Monument Street, Suite 2-500, Baltimore, MD, 21287, USA
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Jeanne M Pinto
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, The Johns Hopkins University School of Medicine, David M. Rubenstein Building, Suite 3070, 200 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Maureen A Lefton-Greif
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, The Johns Hopkins University School of Medicine, David M. Rubenstein Building, Suite 3017, 200 North Wolfe Street, Baltimore, MD, 21287, USA
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| |
Collapse
|
24
|
Streppel M, Veder LL, Pullens B, Joosten KFM. Swallowing problems in children with a tracheostomy tube. Int J Pediatr Otorhinolaryngol 2019; 124:30-33. [PMID: 31154120 DOI: 10.1016/j.ijporl.2019.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Swallowing problems in children with a tracheostomy tube seem to be a common problem, although exact prevalence is not known. The aim of this study is to identify the prevalence and type of swallowing problems in children with a tracheostomy tube. METHODS We retrospectively included 44 children having a tracheostomy tube at Erasmus MC-Sophia Children's hospital. Assessment by a specialized speech and language therapist, the Modified Evans Blue Dye test, Video Fluoroscopic Swallowing Study and a Fiber-optic Endoscopic Evaluation of Swallowing were reviewed with regard to the different phases of swallowing, in particular signs of aspiration. RESULTS In our cohort, 31 (70%) children with a tracheostomy tube presented with problems in the oral and/or the pharyngeal phase of swallowing. Overall 19 (43%) children aspirated. CONCLUSIONS The majority of children with a tracheostomy tube have swallowing problems in the different swallowing phases with a high risk for aspiration.
Collapse
Affiliation(s)
- Marloes Streppel
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Laura L Veder
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Bas Pullens
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Koen F M Joosten
- Department of Pediatrics, Pediatric Intensive Care Unit, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| |
Collapse
|
25
|
Wick EH, Johnson K, Demarre K, Faherty A, Parikh S, Horn DL. Reliability and Construct Validity of the Penetration-Aspiration Scale for Quantifying Pediatric Outcomes after Interarytenoid Augmentation. Otolaryngol Head Neck Surg 2019; 161:862-869. [PMID: 31426703 DOI: 10.1177/0194599819856299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the reliability and construct validity of the Penetration-Aspiration Scale in children. STUDY DESIGN This was a retrospective cohort study of pre- and postoperative video modified barium swallow studies from children who underwent interarytenoid injection augmentation for unexplained persistent pharyngeal dysphagia. Two pediatric speech and language pathologists reviewed each study twice in a blinded and randomized fashion. SETTING Tertiary academic pediatric hospital. SUBJECTS AND METHODS Thirty children were identified with adequate pre- and postoperative modified barium swallow studies within 4 weeks of intervention. Children were separated into clinical outcome groups based on ability to advance to thinner diet consistencies postoperatively. Construct validity was assessed with a mixed linear model to test the hypothesis that only the clinically improved group would receive better Penetration-Aspiration Scale scores after surgery. Reliability was assessed by calculating chance-corrected agreement between raters (interrater) and raters' repeat evaluations (intrarater). RESULTS Inter- and intrarater reliabilities (Cohen's κ) were both excellent. Results of the mixed model revealed a significant interaction between outcome group and pre- and postoperative time interval. As hypothesized, this involved a significant improvement in Penetration-Aspiration Scale score only in the improved group. CONCLUSIONS These findings suggest that the Penetration-Aspiration Scale is a reliable and valid measure of clinical response to interarytenoid injection augmentation in children.
Collapse
Affiliation(s)
- Elizabeth H Wick
- Department of Otolaryngology, Barnes-Jewish Hospital-Washington University in St Louis, St Louis, Missouri, USA
| | - Kaalan Johnson
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA.,Department of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kim Demarre
- Department of Speech and Language Pathology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Amy Faherty
- Department of Speech and Language Pathology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sanjay Parikh
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA.,Department of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - David L Horn
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA.,Department of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| |
Collapse
|
26
|
Duncan DR, Growdon AS, Liu E, Larson K, Gonzalez M, Norris K, Rosen RL. The Impact of the American Academy of Pediatrics Brief Resolved Unexplained Event Guidelines on Gastrointestinal Testing and Prescribing Practices. J Pediatr 2019; 211:112-119.e4. [PMID: 31103259 PMCID: PMC6984037 DOI: 10.1016/j.jpeds.2019.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine if hospitalization, testing, diagnosis, and management of suspected gastroesophageal reflux, and follow-up visits decreased since introduction of American Academy of Pediatrics guidelines for brief resolved unexplained events (BRUEs). STUDY DESIGN We performed a retrospective cohort study of infants with BRUE evaluated at Boston Children's Hospital in the year before and after guideline implementation to determine if practice patterns have changed. Outcomes included hospitalization rates, frequency of swallow assessments, other diagnostic testing, and reflux diagnoses, cost of care, and number of repeat visits. Groups were compared based on whether they presented before or after guideline implementation. RESULTS In total, 359 subjects (186 pre-, 173 post-guidelines) were identified. There were no significant differences in practice patterns or outcomes before or after guideline implementation. Subjects had mean age 2.53 ± 0.15 months, and 80% were hospitalized for 2.49 ± 0.26 days. Each subject had 2.47 diagnostic tests performed, and 89% were noncontributory. Despite only 13% having videofluoroscopic swallow study performed, 72% showed aspiration/penetration. No subject had gastroesophageal reflux testing, yet reflux was implicated as the cause for admission in 40% of subjects, resulting in increased odds of discharge on acid suppressing medications (OR 2.88, 95% CI 1.68-4.92, P = .0001). In follow-up, 28% of subjects had repeat hospitalizations or emergency department visits for persistent symptoms. CONCLUSIONS Infants with BRUE continue to undergo low-yield diagnostic testing and after admission remain symptomatic and frequently re-present to medical care. Swallow testing remains infrequent despite its high-yield, reflux continues to be implicated and children are still being discharged on acid suppression despite lack of efficacy.
Collapse
Affiliation(s)
- Daniel R Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | - Amanda S Growdon
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | - Madeline Gonzalez
- Department of Reimbursement and Decision Support, Boston Children's Hospital, Boston, MA
| | - Kerri Norris
- Department of Reimbursement and Decision Support, Boston Children's Hospital, Boston, MA
| | - Rachel L Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA.
| |
Collapse
|
27
|
Layly J, Marmouset F, Chassagnon G, Bertrand P, Sirinelli D, Cottier JP, Morel B. Can We Reduce Frame Rate to 15 Images per Second in Pediatric Videofluoroscopic Swallow Studies? Dysphagia 2019; 35:296-300. [DOI: 10.1007/s00455-019-10027-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/30/2019] [Accepted: 05/31/2019] [Indexed: 12/21/2022]
|
28
|
Im HW, Kim SY, Oh BM, Han TR, Seo HG. Radiation Dose During Videofluoroscopic Swallowing Studies and Associated Factors in Pediatric Patients. Dysphagia 2019; 35:84-89. [DOI: 10.1007/s00455-019-10006-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
|
29
|
Re GL, Vernuccio F, Di Vittorio ML, Scopelliti L, Di Piazza A, Terranova MC, Picone D, Tudisca C, Salerno S. Swallowing evaluation with videofluoroscopy in the paediatric population. ACTA ACUST UNITED AC 2019; 39:279-288. [PMID: 30933173 PMCID: PMC6843585 DOI: 10.14639/0392-100x-1942] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/15/2018] [Indexed: 11/23/2022]
Affiliation(s)
- G Lo Re
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - F Vernuccio
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - M L Di Vittorio
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - L Scopelliti
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - A Di Piazza
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - M C Terranova
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - D Picone
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - C Tudisca
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - S Salerno
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| |
Collapse
|
30
|
Feeding Interventions Are Associated With Improved Outcomes in Children With Laryngeal Penetration. J Pediatr Gastroenterol Nutr 2019; 68:218-224. [PMID: 30320668 PMCID: PMC6501833 DOI: 10.1097/mpg.0000000000002167] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To determine if children with laryngeal penetration on videofluoroscopic swallow study (VFSS) who received feeding interventions (thickened liquids, change in liquid flow rate, and/or method of liquid delivery) had improved symptoms and decreased hospitalizations compared with those without intervention. METHODS We performed a retrospective cohort study of children under 2 years with laryngeal penetration on VFSS at our institution in 2015 to determine initial and follow-up VFSS findings, symptom improvement at follow-up, and hospitalization risk before and after VFSS. Proportions were compared with Fisher exact test and hospitalizations with paired t tests. RESULTS We evaluated 137 subjects with age 8.93 ± 0.59 months who had laryngeal penetration without aspiration on VFSS. Fifty-five percent had change in management, with 40% receiving thickening and 15% a change in flow rate. There was significant improvement in symptoms for children that had feeding intervention and this improvement was the greatest with thickening (OR 41.8, 95% CI 12.34-141.69, P < 0.001). On repeat VFSS, 26% had evidence of aspiration that was not captured on initial VFSS. Subjects had decreased total and pulmonary hospitalizations with feeding intervention and decreased pulmonary nights with thickening (P < 0.05). CONCLUSIONS Laryngeal penetration appears to be clinically significant in children with oropharyngeal dysphagia and interventions to decrease its occurrence are associated with improved outcomes including decreased symptoms of concern and hospitalization nights. Thickening or other feeding intervention should be considered for all symptomatic children with laryngeal penetration on swallow study.
Collapse
|
31
|
Standardization of Radiologic Procedures for Pediatric Videofluoroscopic Swallow Studies: A Service-based Quality Improvement Initiative. Pediatr Qual Saf 2018; 3:e123. [PMID: 31334455 PMCID: PMC6581479 DOI: 10.1097/pq9.0000000000000123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/11/2018] [Indexed: 01/29/2023] Open
Abstract
Introduction The videofluoroscopic swallow study (VFSS) remains the primary method to evaluate swallowing function in infants and children. However, limited standards exist to guide the image acquisition during pediatric VFSSs, leading to inadequate images, variable assessment quality, and potential for suboptimal diagnostic accuracy. The goal of this quality improvement project was to standardize the radiological procedure for radiologists at our institution. Methods A multidisciplinary team of project leaders established 3 imaging standards to target (magnification, the field of view, and pulse repetition rate), based on the best available evidence. The team used the Institute for Healthcare Improvement's Model for Improvement to guide the project, identified key drivers, and implemented specific interventions. Project leaders observed a total of 170 VFSS examinations, performed by radiology faculty, fellows, and residents over 24 months. The primary outcome for this project was physician compliance with 3 established imaging standards: field of view, magnification, and pulse repetition rate. Project leaders collected data without the radiologists' knowledge, and also recorded average radiation exposure as a balancing measure during this process. Results At baseline, compliance with all 3 criteria was 20%. Following interventions designed to improve radiologist performance with the 3 identified standards, the compliance rate reached 100% for the last 50 recorded VFSSs. During this same time, there was no meaningful increase in average radiation exposure compared with the 6 months before the implementation of this project. Conclusions Compliance with standardized image acquisition of VFSSs can be accomplished using a systematic quality improvement protocol targeting simple, inexpensive interventions.
Collapse
|
32
|
Duncan DR, Mitchell PD, Larson K, Rosen RL. Presenting Signs and Symptoms do not Predict Aspiration Risk in Children. J Pediatr 2018; 201:141-146. [PMID: 29960768 PMCID: PMC6412137 DOI: 10.1016/j.jpeds.2018.05.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/02/2018] [Accepted: 05/16/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine if any presenting symptoms are associated with aspiration risk, and to evaluate the reliability of clinical feeding evaluation (CFE) in diagnosing aspiration compared with videofluoroscopic swallow study (VFSS). STUDY DESIGN We retrospectively reviewed records of children under 2 years of age who had evaluation for oropharyngeal dysphagia by CFE and VFSS at Boston Children's Hospital and compared presenting symptoms, symptom timing, and CFE and VFSS results. We investigated the relationship between symptom presence and aspiration using the Fisher exact test and stepwise logistic regression with adjustment for comorbidities. CFE and VFSS results were compared using the McNemar test. Intervals from CFE to VFSS were compared using the Student t test. RESULTS A total of 412 subjects with mean (±SD) age 8.9 ± 6.9 months were evaluated. No symptom, including timing relative to meals, predicted aspiration on VFSS. This lack of association between symptoms and VFSS results persisted even in the adjusted multivariate model. The sensitivity of CFE for predicting aspiration by VFSS was 44%. Patients with a reassuring CFE waited 28.2 ± 8.5 days longer for confirmatory VFSS compared with those with a concerning CFE (P < .05). CONCLUSIONS Presenting symptoms are varied in patients with aspiration and cannot be relied upon to determine which patients have aspiration on VFSS. The CFE does not have the sensitivity to consistently diagnose aspiration so a VFSS should be performed in persistently symptomatic patients.
Collapse
Affiliation(s)
- Daniel R. Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Paul D. Mitchell
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Rachel L. Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| |
Collapse
|
33
|
Stewart AJ, Butler CR, Muthialu N, Sell D, Marchant J, Hewitt RJD, Elliott MJ. Swallowing outcomes in children after slide tracheoplasty. Int J Pediatr Otorhinolaryngol 2018; 108:85-90. [PMID: 29605373 DOI: 10.1016/j.ijporl.2018.02.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Slide tracheoplasty is now considered gold standard treatment for long segment congenital tracheal stenosis. Outcomes are typically focused upon airway patency. Dysphagia is often reported in children undergoing cardiothoracic surgery, but not specifically after slide tracheoplasty. This study was carried out to describe the nature and prevalence of dysphagia following slide tracheoplasty for long segment congenital tracheal stenosis. METHODS Retrospective case note review was conducted on a series of patients who underwent swallow evaluation following slide tracheoplasty between 2006 and 2014. A clinical swallow assessment was carried out by a Speech and Language Therapist with videofluoroscopic evaluation of swallowing where indicated. Logistic regression assessed the impact of gender, feeding history, weight, tracheal diameter, stenting and co-morbidities on the likelihood of having post-operative dysphagia. RESULTS 43 out of 83 slide tracheoplasty patients underwent swallow evaluation. Dysphagia was identified in 30 (70%) of 43 patients. Videofluoroscopy was undertaken in 22 of these patients. All patients who had a videofluoroscopy presented with altered swallow physiology. Aspiration risk was confirmed in 15 patients with frank aspiration seen in 9. Pre-operative history of dysphagia was present in 9 patients. There were two cases of vocal fold palsy. The presence of a stent was the strongest predictor of post-operative dysphagia with an odds ratio of 10.6 (95% CI 1.2-92.8). CONCLUSIONS This study documents a high prevalence of post-operative dysphagia in a pediatric population following slide tracheoplasty. In most cases there was no history suggestive of dysphagia pre-operatively. Swallowing needs to be assessed after slide tracheoplasty and longitudinal studies are required.
Collapse
Affiliation(s)
- Alexandra J Stewart
- Department of Speech and Language Therapy, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
| | - Colin R Butler
- The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Nagarajan Muthialu
- The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Debbie Sell
- Department of Speech and Language Therapy, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Joseph Marchant
- Department of Speech and Language Therapy, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Richard J D Hewitt
- The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Martin J Elliott
- The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| |
Collapse
|
34
|
Abstract
Feeding problems in infants and young children are common. In healthy children who are developing and growing normally, feeding problems are usually not serious and can be managed conservatively by reassuring the family and providing them with anticipatory guidance and follow-up. A majority of serious childhood feeding problems occur in children who have other medical, developmental, or behavioral problems. These are best evaluated and treated by an interprofessional team who can identify and address issues in the medical and/or developmental history, problems with oral motor control and function, problems with swallowing, and behavioral and/or sensory issues that may interfere with normal feeding.
Collapse
Affiliation(s)
- Kathleen C Borowitz
- Department of Therapy Services, University of Virginia Health System, Box 386 HSC, Charlottesville, VA 22908, USA.
| | - Stephen M Borowitz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Virginia, Box 386 HSC, Charlottesville, VA 22908, USA
| |
Collapse
|
35
|
Frakking TT, Chang AB, O'Grady KAF, David M, Weir KA. Reliability for detecting oropharyngeal aspiration in children using cervical auscultation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:569-577. [PMID: 27686754 DOI: 10.1080/17549507.2016.1222452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 08/05/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Limited data exist that support the reproducibility of cervical auscultation (CA) use in children. This study aimed to determine the reliability of CA in detecting oropharyngeal aspiration (OPA) in children within a controlled environment. METHOD This observational study included eight speech-language pathologists who rated clips of 40 normal and 40 OPA swallowing sounds on two separate occasions (i.e.160 sound clips rated by each speech-language pathologist) to comprise a total of 1280 swallow clips rated. Swallowing sound clips were collected from (1) a volunteer sample of 20 healthy children from the general community (mean 16.2 ± 10.7 months; 65% female); (2) a referred sample of 19 children with demonstrated OPA (mean 22.8 ± 25.5 months; 36.8% female), as determined on videofluoroscopic swallow studies (VFSS) using the Penetration-Aspiration Scale (PAS) (≥6 score). RESULT Inter-rater reliability was very good (kappa =0.81, 95%CI 0.79-0.84). Intra-rater reliability for each rater was good to very good (kappa range 0.72-0.98). Overall sensitivity was 93.9% (95%CI 91.8-95.6) and specificity was 94.5% (95%CI 92.5-96.2). High reliability values were found for the detection of OPA versus normal swallows using CA alone. CONCLUSION Future research should investigate the use of CA in a variety of clinical settings with less environmental control before CA can be advocated for use in routine clinical practice.
Collapse
Affiliation(s)
- Thuy T Frakking
- a Centre for Children's Health Research, The University of Queensland , Brisbane , Australia
- b Speech Pathology Department , Caboolture Hospital , Brisbane , Australia
| | - Anne B Chang
- c Queensland Children's Respiratory Centre, Royal Children's Hospital , Brisbane , Australia
- d Child Health Division, Menzies School of Health Research , Charles Darwin University , Darwin , Australia
- e Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology , Brisbane , Australia
| | - Kerry-Ann F O'Grady
- e Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology , Brisbane , Australia
| | - Michael David
- a Centre for Children's Health Research, The University of Queensland , Brisbane , Australia
- f School of Public Health , The University of Queensland , Brisbane , Australia , and
| | - Kelly A Weir
- a Centre for Children's Health Research, The University of Queensland , Brisbane , Australia
- b Speech Pathology Department , Caboolture Hospital , Brisbane , Australia
- g Menzies Health Institute Queensland , Griffith University , Gold Coast , Australia
| |
Collapse
|
36
|
van de Lande LS, Caron CJJM, Pluijmers BI, Joosten KFM, Streppel M, Dunaway DJ, Koudstaal MJ, Padwa BL. Evaluation of Swallow Function in Patients with Craniofacial Microsomia: A Retrospective Study. Dysphagia 2017; 33:234-242. [PMID: 29103155 PMCID: PMC5866261 DOI: 10.1007/s00455-017-9851-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/19/2017] [Indexed: 11/29/2022]
Abstract
Craniofacial microsomia (CFM) is characterized by underdevelopment of the structures derived from the first and second pharyngeal arches resulting in aesthetic, psychological, and functional problems including feeding and swallowing difficulties. The aim of this study is to gain more insight into swallowing difficulties in patients with CFM. A retrospective study was conducted in the population of patients diagnosed with CFM at three major craniofacial units. Patients with feeding difficulties and those who underwent video fluoroscopic swallow (VFS) studies were included for further analyses. The outcome of the VFS-studies was reviewed with regard to the four phases of swallowing. In our cohort, 13.5% of the 755 patients were diagnosed with swallowing difficulties. The outcome of the VFS-studies of 42 patients showed difficulties in the oral and pharyngeal phases with both thin and thick liquids. Patients with more severe mandibular hypoplasia showed more difficulties to form an appropriate bolus compared to patients who were less severely affected. This is the first study to document swallowing problems in patients with CFM. Difficulties were seen in both the oral and pharyngeal phases. We recommend routine screening for swallowing issues by a speech and language therapist in all patients with CFM and to obtain a VFS-study in patients with a type III mandible.
Collapse
Affiliation(s)
- Lara S van de Lande
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus MC, Sophia Children's Hospital Rotterdam, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Cornelia J J M Caron
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus MC, Sophia Children's Hospital Rotterdam, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Britt I Pluijmers
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus MC, Sophia Children's Hospital Rotterdam, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Koen F M Joosten
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus MC, Sophia Children's Hospital Rotterdam, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Marloes Streppel
- The Dutch Craniofacial Center, Department of Ear, Nose and Throat Surgery, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - David J Dunaway
- The Craniofacial Unit, Great Ormond Street Hospital, London, UK
| | - Maarten J Koudstaal
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus MC, Sophia Children's Hospital Rotterdam, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.,The Craniofacial Unit, Great Ormond Street Hospital, London, UK.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, USA
| | - Bonnie L Padwa
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, USA
| |
Collapse
|
37
|
First Steps Towards Development of an Instrument for the Reproducible Quantification of Oropharyngeal Swallow Physiology in Bottle-Fed Children. Dysphagia 2017; 33:76-82. [PMID: 28894942 DOI: 10.1007/s00455-017-9834-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 08/04/2017] [Indexed: 10/18/2022]
Abstract
The incidence of feeding/swallowing impairments (deglutition disorders) in young children is rising and poses serious acute and long-term health consequences. Accurate detection and prompt intervention can lessen the impact of dysphagia-induced sequelae. Videofluoroscopic Swallow Studies (VFSSs) are used to make critical decisions for medically fragile children despite procedural variability and the lack of agreed upon measures for interpreting and reporting results. This investigation represents the first steps in the development of a novel tool for the quantification of oropharyngeal swallow physiology from full-length VFSS examinations in bottle-fed children. The Modified Barium Swallow Impairment Profile MBSImP™© served as the conceptual assessment model for development of components and operational score variants to characterize distinguishable VFSS observations. Twenty-four components of swallowing physiology were validated via expert consensus. Training materials included a library of 94 digitized video images comprised of distinct score variants for each component. Materials were disseminated to seven speech-language pathologists (SLPs) who participated in didactic and self-training sessions, and rated components. All SLPs achieved ≥80% reliability criterion after completing two or three training sessions. Agreement for 17 (71%) components was achieved after two sessions. Nutritive sucking/oral and airway-related components were most difficult to distinguish. Three sessions were required for 2 (33%) of the sucking/oral components and 4 (57%) of the airway-related components. These findings support the feasibility to standardize training and reliably score swallowing physiology using precise definitions and unambiguous visual images, and represent preliminary steps towards content validity and reliability of a standardized VFSS tool for bottle-fed children.
Collapse
|
38
|
Audag N, Goubau C, Toussaint M, Reychler G. Screening and evaluation tools of dysphagia in children with neuromuscular diseases: a systematic review. Dev Med Child Neurol 2017; 59:591-596. [PMID: 27935021 DOI: 10.1111/dmcn.13354] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 12/14/2022]
Abstract
AIM Dysphagia is frequent in paediatric patients with neuromuscular diseases (pNMD). Its detection is important for initiating early diagnosis and treatment as well as for minimizing related complications. The aim of this study was to review the literature on dysphagia screening and evaluation tools in pNMD. METHOD A systematic review was performed on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (PubMed, CINAHL, and ScienceDirect) were searched. Measurement properties of tools and the quality index developed by Downs and Black were considered. RESULTS Our search yielded four studies and four different tools for paediatric patients with Duchenne muscular dystrophy (DMD). The Sydney Swallow Questionnaire, surface electromyography, Neuromuscular Disease Swallowing Status Scale, and videofluoroscopic swallow study showed interesting properties for DMD. No data were available for other NMD and children under 9 years. The mean total score for the quality index was 17.5. INTERPRETATION We did not identify any superior validated tools, either for screening or for evaluation of dysphagia, and no widely accepted protocol. Further studies are needed to identify the simplest assessment with the best psychometric properties for pNMD. We recommend establishing a specific tool for pNMD.
Collapse
Affiliation(s)
- Nicolas Audag
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium
| | - Christophe Goubau
- Unité de Pneumologie Pédiatrique, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|
39
|
Bar-Sever Z. Scintigraphic Evaluation of Gastroesophageal Reflux and Pulmonary Aspiration in Children. Semin Nucl Med 2017; 47:275-285. [PMID: 28417856 DOI: 10.1053/j.semnuclmed.2016.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Gastroesophageal reflux (GER) and pulmonary aspiration are encountered in children of all ages. Signs, symptoms, and complications vary from mild and transient to severe life-threatening conditions. This review will present relevant clinical information on these conditions as well as common diagnostic procedures. The role of scintigraphic techniques used in the evaluation of these conditions will be discussed in detail including protocols and performance in comparison to other diagnostic methods.
Collapse
Affiliation(s)
- Zvi Bar-Sever
- Department of nuclear medicine, Schneider Children's Medical Center, Petah Tikva, Israel.
| |
Collapse
|
40
|
Viviers M, Kritzinger A, Vinck B, Graham M. Preliminary psychometric performance of the Neonatal Feeding Assessment Scale. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2017; 64:e1-e8. [PMID: 28155281 PMCID: PMC5843074 DOI: 10.4102/sajcd.v64i1.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 11/11/2016] [Accepted: 09/22/2016] [Indexed: 12/01/2022] Open
Abstract
Objective The objective was to determine the preliminary psychometric performance of a new clinical feeding scale to diagnose oropharyngeal dysphagia (OPD) in neonates. Methods Twenty neonates with a median gestational age of 35 weeks were evaluated using the Neonatal Feeding Assessment Scale (NFAS) and modified barium swallow studies (MBSS). The results were compared. Results Nine of the 20 participants presented with OPD on the NFAS. Comparison of the scale’s results with instrumental MBSS indicated that all participants without OPD were correctly excluded (100% sensitivity). The specificity was 78.6%, indicating that three participants were falsely identified with OPD on the scale. Inter-rater reliability was determined on 50% (n = 10) of the sample. Substantial agreement (80%) was obtained between two raters in five of the six sections of the scale and on the diagnostic outcome. Conclusion The preliminary performance of the scale appears to be promising. A further validation study will take place.
Collapse
Affiliation(s)
- Mari Viviers
- Department of Speech-Language Pathology and Audiology, University of Pretoria.
| | | | | | | |
Collapse
|
41
|
Henderson M, Miles A, Holgate V, Peryman S, Allen J. Application and Verification of Quantitative Objective Videofluoroscopic Swallowing Measures in a Pediatric Population with Dysphagia. J Pediatr 2016; 178:200-205.e1. [PMID: 27568657 DOI: 10.1016/j.jpeds.2016.07.050] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/14/2016] [Accepted: 07/28/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the feasibility of obtaining and utilizing objective measures of timing and displacement from videofluoroscopy performed in pediatrics. STUDY DESIGN Children (n = 121; mean age 38 months, range 9 days-21 years, SD 4 years) referred for videofluoroscopy were recruited. All underwent a standardized protocol including a mid-feed 20-second loop recorded at 25 frames per second. Videos were analyzed using objective digital measures of timing and displacement. Radiation dose was recorded. RESULTS Quantitative measures were obtained in all children. Maximum opening of the pharyngoesophageal segment and timing measures were correlated with increasing age. Values were congruent with validated adult data. Mean radiation time was 1.58 minutes (range 0.15-3.47, SD 0.66), and mean radiation dose was 30.16 cGycm2 (range 6.5-85 SD 15.17). Radiation dose (P = .21) and radiation time (P = .72) were not significantly different using the increased frame rate compared with an age-matched cohort (n =100) prior to protocol change. CONCLUSIONS Objective quantitative measures of swallowing measurements can be obtained successfully from pediatric videofluoroscopy performed at high frame rates, without increasing radiation dose. Measures are biologically consistent, reproducible, demonstrate internal cross-correlation, and mirror adult data. These measures have potential to support targeted management and objective monitoring of change by pediatric feeding teams in the future.
Collapse
Affiliation(s)
- Mandy Henderson
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand; Speech Science, The University of Auckland, Auckland, New Zealand
| | - Anna Miles
- Speech Science, The University of Auckland, Auckland, New Zealand.
| | - Victoria Holgate
- Speech Science, The University of Auckland, Auckland, New Zealand
| | - Sophia Peryman
- Radiology, Waitemata District Health Board, Auckland, New Zealand
| | - Jacqui Allen
- Speech Science, The University of Auckland, Auckland, New Zealand; Otolaryngology, Waitemata District Health Board, Surgery, University of Auckland, Auckland, New Zealand
| |
Collapse
|
42
|
Hersh C, Wentland C, Sally S, de Stadler M, Hardy S, Fracchia MS, Liu B, Hartnick C. Radiation exposure from videofluoroscopic swallow studies in children with a type 1 laryngeal cleft and pharyngeal dysphagia: A retrospective review. Int J Pediatr Otorhinolaryngol 2016; 89:92-6. [PMID: 27619036 DOI: 10.1016/j.ijporl.2016.07.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/22/2016] [Accepted: 07/22/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Radiation exposure is recognized as having long term consequences, resulting in increased risks over the lifetime. Children, in particular, have a projected lifetime risk of cancer, which should be reduced if within our capacity. The objective of this study is to quantify the amount of ionizing radiation in care for children being treated for aspiration secondary to a type 1 laryngeal cleft. With this baseline data, strategies can be developed to create best practice pathways to maintain quality of care while minimizing radiation exposure. METHODS Retrospective review of 78 children seen in a tertiary pediatric aerodigestive center over a 5 year period from 2008 to 2013 for management of a type 1 laryngeal cleft. The number of videofluoroscopic swallow studies (VFSS) per child was quantified, as was the mean effective dose of radiation exposure. The 78 children reviewed were of mean age 19.9 mo (range 4 mo-12 years). All children were evaluated at the aerodigestive center with clinical symptomatology and subsequent diagnosis of a type 1 laryngeal cleft. Aspiration was assessed via VFSS and exposure data collected. Imaging exams where dose parameters were not available were excluded. RESULTS The mean number of VFSS each child received during the total course of treatment was 3.24 studies (range 1-10). The average effective radiation dose per pediatric VFSS was 0.16 mSv (range: 0.03 mSv-0.59 mSv) per study. Clinical significance was determined by comparison to a pediatric CXR. At our facility a CXR yields an effective radiation dose of 0.017 mSv. Therefore, a patient receives an equivalent total of 30.6 CXR over the course of management. CONCLUSIONS Radiation exposure has known detrimental effects particularly in pediatric patients. The total ionizing radiation from VFSS exams over the course of management of aspiration has heretofore not been reported in peer reviewed literature. With this study's data in mind, future developments are indicated to create innovative clinical pathways and limit radiation exposure.
Collapse
Affiliation(s)
- Cheryl Hersh
- Department of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, 275 Cambridge Street POB 3, Boston, MA 02114, United States.
| | - Carissa Wentland
- Pediatric Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
| | - Sarah Sally
- Department of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, 275 Cambridge Street POB 3, Boston, MA 02114, United States.
| | - Marie de Stadler
- Department of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, 275 Cambridge Street POB 3, Boston, MA 02114, United States.
| | - Steven Hardy
- Pediatric Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - M Shannon Fracchia
- Pediatric Pulmonary Division, Massachusetts General Hospital, 275 Cambridge Street POB 5, Boston, MA 02114, United States.
| | - Bob Liu
- Department of Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Christopher Hartnick
- Pediatric Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
| |
Collapse
|
43
|
The Use of Cervical Auscultation to Predict Oropharyngeal Aspiration in Children: A Randomized Controlled Trial. Dysphagia 2016; 31:738-748. [DOI: 10.1007/s00455-016-9727-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/02/2016] [Indexed: 10/21/2022]
|
44
|
Abstract
Laryngotracheoesophageal clefts are rare congenital anomalies of the aerodigestive tract. Patients may present with airway and/or swallowing impairments. An approach to evaluation and management is presented. Important pearls for conservative and surgical management are discussed. Open versus endoscopic surgical techniques are reviewed.
Collapse
Affiliation(s)
- Julie E Strychowsky
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, Western University, 800 Commissioners Rd. E., London, Ontario, Canada
| | - Reza Rahbar
- Department of Otolaryngology, Communication Enhancement, Harvard University, Boston Children's Hospital, 300 Longwood Ave, LO-367, Boston, MA 02115.
| |
Collapse
|
45
|
Strychowsky JE, Dodrill P, Moritz E, Perez J, Rahbar R. Swallowing dysfunction among patients with laryngeal cleft: More than just aspiration? Int J Pediatr Otorhinolaryngol 2016; 82:38-42. [PMID: 26857313 DOI: 10.1016/j.ijporl.2015.12.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/30/2015] [Accepted: 12/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Modified Barium Swallow (MBS) is the most widely utilized instrumental assessment of swallowing disorders in children; however, the exact role in the evaluation of laryngeal clefts remains controversial. METHODS This study was an IRB-approved retrospective review on patients diagnosed with laryngeal cleft from 2002 to 2014. The objective was to describe the range of swallowing dysfunction that may be present in patients with laryngeal clefts both pre- and post-intervention (conservative management versus surgery). A speech-language pathologist reviewed MBS studies and medical records to determine Penetration-Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS) scores. RESULTS One hundred seventy-five patients who underwent laryngeal cleft repair during the study period (type 1, n=111; type 2, n=54; type 3, n=9; type 4, n=1) were included. Fifty patients who were managed conservatively (type 1) were also included. Swallowing impairment was demonstrated in all phases of swallowing for all cleft types. Oral phase impairment ranged from 27-67% pre-intervention to 19-75% post-intervention, triggering impairment from 24-42% pre-intervention to 24-75% post-intervention, and pharyngeal phase impairment (laryngeal penetration and aspiration) from 57-100% pre-intervention to 40-100% post-intervention. Laryngeal penetration and aspiration on thin and thick liquids, silent aspiration, PAS, and FOIS scores are reported. Significant improvements in swallowing function (p<0.05) were documented in all of the conservatively and surgically managed sub-groups. CONCLUSIONS The MBS study is a useful tool for evaluating swallowing function in patients with laryngeal cleft and provides information beyond the lack or presence of aspiration. Understanding impairments in all phases of swallowing may be beneficial for perioperative management.
Collapse
Affiliation(s)
- Julie E Strychowsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA; Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, 800 Commissioners Rd E, VH B3-444, London, ON, N6A 5W9, Canada.
| | - Pamela Dodrill
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA.
| | - Ethan Moritz
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA.
| | - Jennifer Perez
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA.
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
46
|
Comparison of image quality and radiation dose between an image-intensifier system and a newer-generation flat-panel detector system — technical phantom measurements and evaluation of clinical imaging in children. Pediatr Radiol 2016; 46:286-92. [PMID: 26481334 DOI: 10.1007/s00247-015-3456-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/04/2015] [Accepted: 08/17/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Many image-intensifier fluoroscopy systems have been replaced by flat-panel detectors in recent years. OBJECTIVE To compare the level of contrast, image resolution and radiation dose between an image-intensifier and a newer-generation flat-panel detector system in a pediatric radiology unit. MATERIALS AND METHODS We compared two systems — a conventional image intensifier and a newer-generation flat-panel system. We measured image quality and radiation dose using a technical phantom. Additionally, we retrospectively compared age-matched fluoroscopic pediatric voiding cystourethrography (n = 15) and upper gastrointestinal investigations (n = 25). RESULTS In phantom studies image contrast was equal while image resolution was higher and mean radiation dose lower using the flat-panel system (P < 0.0001). In pediatric investigations, mean dose area product was significantly reduced on the flat-panel system for upper gastrointestinal investigation (45 ± 38 μGy*m2 vs. 11 ± 9 μGy*m2; P < 0.0001) and for voiding cystourethrography (18 ± 20 μGy*m2 vs. 10 ± 12 μGy*m2; P = 0.04). CONCLUSION The newer flat-panel system performs at lower dose levels with equal to better image quality and therefore seems to be the more suitable technique for pediatric fluoroscopy in comparison to image-intensifier systems.
Collapse
|
47
|
Coppens CH, van den Engel-Hoek L, Scharbatke H, de Groot SAF, Draaisma JM. Dysphagia in children with repaired oesophageal atresia. Eur J Pediatr 2016; 175:1209-1217. [PMID: 27544282 PMCID: PMC5005404 DOI: 10.1007/s00431-016-2760-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/04/2016] [Indexed: 12/29/2022]
Abstract
UNLABELLED Dysphagia is a common problem in children with repaired oesophageal atresia (OA). Abnormalities in the oropharyngeal and oesophageal phase have hardly been studied. The aims of this study were to assess the prevalence of dysphagia in children with repaired OA and to identify and differentiate oral and pharyngeal dysphagia based on videofluoroscopic swallow study (VFSS) findings in a limited number of children in this cohort. Medical records of 111 patients, born between January 1996 and July 2013 and treated at the Radboudumc Amalia Children's Hospital, were retrospectively reviewed. The prevalence of dysphagia was determined by the objective and modified Functional Oral Intake Scale (FOIS) in four age groups. The first performed VFSS of 12 children was structurally assessed. The prevalence of dysphagia was 61 of 111 patients (55 %) in age group <1 year. In age group 1-4, 5-11 and 12-18 years, the prevalence of dysphagia decreased from 54 of 106 (51 %) patients to 11 of 64 (17 %) and 5 of 24 (21 %) patients. The 12 VFSS's reviews revealed oral dysphagia in 36 % and pharyngeal dysphagia in 75 %. CONCLUSIONS This study highlights dysphagia as an important problem in different age groups of children with repaired OA. Furthermore, our study shows the presence of oropharyngeal dysphagia in this population. This study emphasizes the need to standardize the use of objective dysphagia scales, like the modified FOIS, to provide a careful follow-up of children with repaired OA. WHAT IS KNOWN • Prevalence of dysphagia in children with repaired oesophageal atresia varies widely (ranges from 45 to 70 %) in literature. • Oral, pharyngeal and oesophageal dysphagia require different treatment approaches. What is New: • We determined dysphagia based on functional oral intake and provide an overview of change in dysphagia prevalence and severity over time in children with repaired OA. • Our study shows that dysphagia, including oropharyngeal dysphagia, is highly prevalent in young children with repaired OA and improves with time.
Collapse
Affiliation(s)
- Catelijne H. Coppens
- Department of Paediatrics, Radboudumc Amalia Children’s Hospital, PO box 9101, 6500 HB Nijmegen, The Netherlands
| | - Lenie van den Engel-Hoek
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Horst Scharbatke
- Department of Paediatric Surgery, Radboudumc Amalia Children’s Hospital, PO box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sandra A. F. de Groot
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Jos. M.T. Draaisma
- Department of Paediatrics, Radboudumc Amalia Children’s Hospital, PO box 9101, 6500 HB Nijmegen, The Netherlands
| |
Collapse
|
48
|
|
49
|
LaMantia AS, Moody SA, Maynard TM, Karpinski BA, Zohn IE, Mendelowitz D, Lee NH, Popratiloff A. Hard to swallow: Developmental biological insights into pediatric dysphagia. Dev Biol 2015; 409:329-42. [PMID: 26554723 DOI: 10.1016/j.ydbio.2015.09.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 12/16/2022]
Abstract
Pediatric dysphagia-feeding and swallowing difficulties that begin at birth, last throughout childhood, and continue into maturity--is one of the most common, least understood complications in children with developmental disorders. We argue that a major cause of pediatric dysphagia is altered hindbrain patterning during pre-natal development. Such changes can compromise craniofacial structures including oropharyngeal muscles and skeletal elements as well as motor and sensory circuits necessary for normal feeding and swallowing. Animal models of developmental disorders that include pediatric dysphagia in their phenotypic spectrum can provide mechanistic insight into pathogenesis of feeding and swallowing difficulties. A fairly common human genetic developmental disorder, DiGeorge/22q11.2 Deletion Syndrome (22q11DS) includes a substantial incidence of pediatric dysphagia in its phenotypic spectrum. Infant mice carrying a parallel deletion to 22q11DS patients have feeding and swallowing difficulties that approximate those seen in pediatric dysphagia. Altered hindbrain patterning, craniofacial malformations, and changes in cranial nerve growth prefigure these difficulties. Thus, in addition to craniofacial and pharyngeal anomalies that arise independently of altered neural development, pediatric dysphagia may result from disrupted hindbrain patterning and its impact on peripheral and central neural circuit development critical for feeding and swallowing. The mechanisms that disrupt hindbrain patterning and circuitry may provide a foundation to develop novel therapeutic approaches for improved clinical management of pediatric dysphagia.
Collapse
Affiliation(s)
- Anthony-Samuel LaMantia
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Sally A Moody
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Anatomy and Regenerative Biology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Thomas M Maynard
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Beverly A Karpinski
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Irene E Zohn
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Center for Neuroscience Research, Children's National Health System, Washington D.C., USA
| | - David Mendelowitz
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Norman H Lee
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Anastas Popratiloff
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Anatomy and Regenerative Biology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| |
Collapse
|
50
|
Kemps G, Sewitch M, Birnbaum R, Daniel SJ. Contrast pooling in videofluoroscopic swallowing study as a risk factor for pneumonia in children with dysphagia. Int J Pediatr Otorhinolaryngol 2015; 79:1306-9. [PMID: 26092551 DOI: 10.1016/j.ijporl.2015.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/28/2015] [Accepted: 05/31/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine if laryngeal contrast pooling on a videofluoroscopic swallowing study increases the risk for pneumonia in the following 6 months in children with dysphagia. Secondarily, to determine in the same population, if laryngeal abnormalities or syndromic disorders increase the risk for pneumonia in the same timeframe. STUDY DESIGN Retrospective cohort study. METHODS A chart review of pediatric patients that presented to the swallowing and dysphagia clinic at the Montreal Children's Hospital for a videofluoroscopic swallowing study in the last three years was conducted. Videofluoroscopic findings, patient characteristics, demographic data, and pneumonias occurring within 6 months after the study were recorded for all patients. Patients with unsuccessful swallowing studies, incomplete charts, extra-laryngeal etiologies for recurrent pneumonia, or who were lost to follow up were excluded. RESULTS Of the 287 children who presented to the clinic, 239 patients remained after exclusion, of which 40 (16.7%) exhibited pooling and 199 (83.3%) did not. Children with pooling on videofluoroscopic swallowing study did not have significantly more pneumonias than patients without pooling (22.5% vs 17.1%, P=0.42). Secondary analyses revealed that laryngeal abnormalities were a significant independent risk factor (P=0.02) for pneumonia at 6 months, while being diagnosed with a syndrome was not (P=0.18). CONCLUSION In this study of contrast pooling in videofluoroscopic swallowing study, there was no significant difference in pneumonia occurrence in patients with and without pooling at 6 months post study. Future prospective studies should be conducted to confirm these findings. The present review showed that feeding changes should not be made based on pooling alone.
Collapse
Affiliation(s)
- Glen Kemps
- Radboud University Nijmegen, Nijmegen, Netherlands; Department of Otolaryngology Head & Neck Surgery, The Montreal Children's Hospital, Montréal, QC, Canada
| | - Maida Sewitch
- Division of Clinical Epidemiology, McGill University Health Centre, Montréal, QC, Canada
| | - Rena Birnbaum
- Department of Occupational Therapy, The Montreal Children's Hospital, Montréal, QC, Canada
| | - Sam J Daniel
- Department of Otolaryngology-Head and Neck Surgery, McGill University, The Montreal Children's Hospital, Montréal, QC, Canada.
| |
Collapse
|