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Hübl N, Riebold B, Schramm D, Seidl RO. Differences in the swallowing process of newborns and healthy preterm infants: first results with a non-invasive bioimpedance and electromyography measurement system. Eur Arch Otorhinolaryngol 2024; 281:843-854. [PMID: 37996534 PMCID: PMC10796423 DOI: 10.1007/s00405-023-08344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE Preterm infants (PI) have difficulty coordinating sucking, swallowing and breathing, and there is a risk of aspiration. The causes of this are not yet sufficiently understood. The aim of this study was to test a novel measurement device to measure breathing and pharyngeal processes involved in swallowing externally in everyday life to identify possible differences in neonates (NB) and PI. METHODS Forty healthy NB were studied at 4-8 weeks of age (mean: 6.7 weeks) and 20 healthy PI (mean gestational age 30.5 weeks) at postmenstrual age (PMA) 34/35 weeks (mean PMA 35.1 weeks) during a single feeding. Surface electrodes were used to measure bioimpedance and electromyography reflecting swallow-related changes in the pharynx and muscle activation of the tongue and submental muscles. A respiratory belt was combined with recording of the depth of chest movements and the occurrence of pauses in breathing. RESULTS Velocity and extent of pharyngeal closure did not differ significantly across the feeding period (velocity: p=0.09, closure: p=0.17), but during the first two suck-swallow bursts PI had greater velocity (p<0.001*) and extent of pharyngeal closure (p=0.004*) than NB. The duration of swallowing phases was significantly longer in PIs (p<0.001*), their muscle activation decreased faster (p<0.001*), and they had more pauses in breathing than NBs. CONCLUSIONS The novel measurement device allowed, for the first time in everyday life, the measurement of factors influencing swallowing and breath-swallow coordination in NBs and PIs. PIs showed differences from NBs most likely due to differences in muscle strength and condition.
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Affiliation(s)
- Nicole Hübl
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Benjamin Riebold
- TU Berlin, Control Systems Group, Einsteinufer 17, 10587, Berlin, Germany
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Rainer O Seidl
- Ear-Nose and Throat, Unfallkrankenhaus Berlin, UKB, Warener Str.7, 12683, Berlin, Germany
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2
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Enteral tube feeding selection at NICU discharge and resource utilization. J Perinatol 2022; 43:647-652. [PMID: 36435925 DOI: 10.1038/s41372-022-01566-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate resource utilization in infants discharged with different forms of feeding access. STUDY DESIGN Retrospective chart review of neonates discharged from 2012 to 2018. Data were collected from the medical record and relevant outcomes were compared. RESULTS 300 patients were sampled. 196 (65%) were discharged on NG feeds, 95 (32%) via GT, and 9 gastrojejunal (GJ 3%). NG-fed infants discharged sooner (mean DOL: NG = 85.4 vs GT = 122.8, p < 0.001). More GT/GJ patients required emergency department (ED) visits for tube complications (GT = 61 vs GJ = 7 vs NG = 42, p < 0.001) and more frequently (mean visits: GT = 1.63 ± 2.33 vs GJ = 4.22 ± 4.44 vs NG = 0.48 ± 1.40, p < 0.001). However, 44 (24%) of the patients discharged on NG later had a GT placed. CONCLUSIONS Many patients discharged from the NICU can be supported with NG feeds. This may shorten hospital stays and decrease ED visits but select patients will later merit surgical tube placement.
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3
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Roland H, Brown A, Rousselot A, Freeman N, Wieting JM, Bergman S, Mondal D. Osteopathic Manipulative Treatment Decreases Hospital Stay and Healthcare Cost in the Neonatal Intensive Care Unit. MEDICINES (BASEL, SWITZERLAND) 2022; 9:49. [PMID: 36286582 PMCID: PMC9607199 DOI: 10.3390/medicines9100049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Osteopathic manipulative treatment (OMT) is used in both inpatient and outpatient settings. Evidence suggests that OMT can reduce both patients' recovery time and the financial cost of their acute medical treatment and rehabilitation. Multiple studies from neonatal intensive care units (NICUs) are presented in this article that demonstrate infants treated with OMT recover faster, are discharged earlier, and have lower healthcare costs than their non-OMT-treated counterparts. Data clearly show that adjunctive OMT facilitates feeding coordination in newborns, such as latching, suckling, swallowing, and breathing, and increases long-term weight gain and maintenance, which reduces hospital length of stay (LOS). Osteopathic techniques, such as soft tissue manipulation, balanced ligamentous tension, myofascial release, and osteopathic cranial manipulation (OCM), can reduce regurgitation, vomiting, milky bilious, or bloody discharge and decrease the need for constipation treatment. OMT can also be effective in reducing the complications of pneumonia in premature babies. Studies show the use of OCM and lymphatic pump technique (LPT) reduces the occurrence of both aspiration and environmentally acquired pneumonia, resulting in significantly lower morbidity and mortality in infants. Based on published findings, it is determined that OMT is clinically effective, cost efficient, a less invasive alternative to surgery, and a less toxic choice to pharmacologic drugs. Therefore, routine incorporation of OMT in the NICU can be of great benefit in infants with multiple disorders. Future OMT research should aim to initiate clinical trial designs that include randomized controlled trials with larger cohorts of infants admitted to the NICU. Furthermore, a streamlined and concerted effort to elucidate the underlying molecular mechanisms associated with the beneficial effects of OMT will aid in understanding the significant value of incorporating OMT into optimal patient care.
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Affiliation(s)
- Hannah Roland
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| | - Amanda Brown
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| | - Amy Rousselot
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| | - Natalie Freeman
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| | - J. Michael Wieting
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 6965 Cumberland Gap Parkway, Harrogate, TN 37752, USA
| | - Stephen Bergman
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 6965 Cumberland Gap Parkway, Harrogate, TN 37752, USA
| | - Debasis Mondal
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
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4
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Deglutition-related cardiorespiratory events. Early Hum Dev 2022; 171:105602. [PMID: 35749800 DOI: 10.1016/j.earlhumdev.2022.105602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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5
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Sobotka SA, Laudon S, Jackson AJ, Harendt SE, Baker CD. A Literature Review of Feeding Disorders in Children with Tracheostomies and Ventilators. Pediatr Ann 2022; 51:e291-e296. [PMID: 35858218 PMCID: PMC9584144 DOI: 10.3928/19382359-20220504-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Feeding disorders and gastrostomy use are highly prevalent in children with invasive mechanical ventilation (IMV) due to both common risk factors (eg, prematurity, neurological disorders) and resultant experiential deprivation (eg, long hospitalizations, delayed feeding experiences). Feeding in children with IMV is complicated by the presence of a tracheostomy, lung vulnerability, and medical complexity. The potential comorbidity of swallowing difficulties (dysphagia) and atypical early feeding experiences can result in complex feeding disorders. In this review of pediatric feeding disorders in children with invasive mechanical ventilation (IMV), we identify gaps in clinical translational research for this patient population and opportunities for improving evidence-based management. To improve long-term feeding outcomes and maximize oral feeding in this vulnerable population, children would benefit from earlier feeding opportunities during critical developmental windows, standardized protocols for advancing oral feeding, and involvement of intensive, comprehensive therapies throughout hospitalizations and early childhood. [Pediatr Ann. 2022;51(7):e291-e296.].
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6
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Dias ML, O'Connor KM, Dempsey EM, O'Halloran KD, McDonald FB. Targeting the Toll-like receptor pathway as a therapeutic strategy for neonatal infection. Am J Physiol Regul Integr Comp Physiol 2021; 321:R879-R902. [PMID: 34612068 DOI: 10.1152/ajpregu.00307.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Toll-like receptors (TLRs) are crucial transmembrane receptors that form part of the innate immune response. They play a role in the recognition of various microorganisms and their elimination from the host. TLRs have been proposed as vital immunomodulators in the regulation of multiple neonatal stressors that extend beyond infection such as oxidative stress and pain. The immune system is immature at birth and takes some time to become fully established. As such, babies are especially vulnerable to sepsis at this early stage of life. Findings suggest a gestational age-dependent increase in TLR expression. TLRs engage with accessory and adaptor proteins to facilitate recognition of pathogens and their activation of the receptor. TLRs are generally upregulated during infection and promote the transcription and release of proinflammatory cytokines. Several studies report that TLRs are epigenetically modulated by chromatin changes and promoter methylation upon bacterial infection that have long-term influences on immune responses. TLR activation is reported to modulate cardiorespiratory responses during infection and may play a key role in driving homeostatic instability observed during sepsis. Although complex, TLR signaling and downstream pathways are potential therapeutic targets in the treatment of neonatal diseases. By reviewing the expression and function of key Toll-like receptors, we aim to provide an important framework to understand the functional role of these receptors in response to stress and infection in premature infants.
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Affiliation(s)
- Maria L Dias
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Karen M O'Connor
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Eugene M Dempsey
- Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland.,Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland.,Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland
| | - Fiona B McDonald
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland.,Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland
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7
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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.
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8
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Matharu P, Cristea AI, Slaven JE, Becker S, Niehaus JZ. Feeding Outcomes for Infants with Bronchopulmonary Dysplasia Discharged on Nasogastric Feeds. Am J Perinatol 2021; 38:897-900. [PMID: 31887745 DOI: 10.1055/s-0039-3401796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE While previous studies regarding neonatal home feeding regimens have demonstrated a more favorable prognosis for nasogastric (NG) versus gastrostomy tubes (GT), institutional practices of discharge on NG feeds are varied, particularly for infants with bronchopulmonary dysplasia (BPD). Little is known regarding the risk factors for patients treated with GT postdischarge in premature infants with BPD. Our objective was to identify frequency and risk factors for treating premature infants with BPD discharged on NG feeds with GT. STUDY DESIGN In this retrospective study, we included infants born at 30 weeks' gestational age with BPD transitioning from a tertiary care center to home on NG feeds from 2010 to 2016. RESULTS Of the 86 infants included in this study, 25 (29%) underwent GT placement at a median age of 264 days postdischarge. Fourteen (56%) were able to remove the GT at a median age of 979.5 days. Infants not requiring GT placement postdischarge were found to have a significantly higher ccipitofrontal circumference (p = 0.0089) and length (p = 0.0166) at discharge compared with infants with GT. CONCLUSION NG feeding for infants with BPD appears to be a viable treatment with fewer patients (29%) requiring GT placement. Gestational age and abnormal magnetic resonance imaging results were found to have a significant association with GT placement postdischarge.
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Affiliation(s)
- Preet Matharu
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - A Ioana Cristea
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Samantha Becker
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - Jason Z Niehaus
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
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9
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Infants without apparent risk factors with aspiration as a cause of respiratory symptoms - a retrospective study. Ir J Med Sci 2020; 190:217-223. [PMID: 32583311 DOI: 10.1007/s11845-020-02282-8] [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: 05/07/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Dysphagia is common in children born prematurely or those with neuromuscular conditions or airway malformations. Few studies have reported on children with isolated dysphagia and there is significant variation in the literature regarding clinical outcomes. AIMS The aim of this study was to characterise the clinical presentation of children with isolated dysphagia as well as the diagnostic evaluation, treatment strategies and clinical outcomes. METHODS A retrospective chart review was conducted of children with isolated dysphagia presenting to a tertiary paediatric centre over a 10-year period. RESULTS We describe these patients' presentation, clinical feeding assessment findings, radiological findings, treatment strategies and outcomes. Seventeen children were identified. Recurrent respiratory tract infections were the most common presentation (82%). Oral feeds were continued in 9 (53%) with the remaining being NG fed. Gastrostomy tubes were required for long-term nutrition in 6/8 (75%) of these cases. At follow-up, 11/17 (65%) had resolution of symptoms and are on full oral feeds. The mean age at resolution is 3.45 years. Of those who required gastrostomy 50% have had them removed. CONCLUSION Isolated dysphagia should be considered in children presenting with recurrent, otherwise unexplained respiratory symptoms. Resolution can take a number of years.
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10
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Development of Swallowing Function in Infants with Oral Feeding Difficulties. Int J Pediatr 2020; 2020:5437376. [PMID: 32089712 PMCID: PMC7023804 DOI: 10.1155/2020/5437376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/14/2019] [Accepted: 01/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Discharge of preterm infants is often delayed because of their oral feeding difficulties. Independent oral feeding is the last obstacle to pass after managing acute and chronic morbidities. We conducted this study to determine the prevalence, characteristics, and risk factors of swallowing dysfunction and suggest proper interventions to reduce aspiration and chronic lung injury. Methods Infants admitted to the neonatal intensive care unit (January 2016 to December 2018) who were performed modified barium swallow study due to oral feeding difficulties were enrolled. Modified barium swallow study was done ≥ postmenstrual age 37 weeks to limit radiation exposure. Clinical data were collected retrospectively. Swallowing dysfunction was defined as inadequate epiglottic closure, laryngeal penetration, or tracheal aspiration according to result of the modified barium swallow study. Results Among a total of 54 infants enrolled, nine (16.7%) were term infants, 13 (24.1%) were late preterm infants (gestational age, 34-36 weeks), and 32 (59.3%) were early preterm infants (gestational age < 34 weeks). Gestational age and birth weight were smaller in infants with swallowing dysfunction. Total duration of mechanical ventilation and duration of invasive ventilation were longer in infants with swallowing dysfunction. The risk of swallowing dysfunction increased by 11.2 times for infants with gestational age < 29 weeks compared to infants with gestational age ≥ 29 weeks. Swallowing dysfunction was improved in most infants after they became matured. They showed different time and rate of maturation with the help of rehabilitation through swallow therapy and dietary modification with thickened formula. Conclusion Preterm infants with gestational age < 29 weeks or with longer ventilation duration are at a higher risk of aspiration. Rehabilitation of swallow therapy and dietary modification with thickened formula can be helpful interventions to prevent aspiration and chronic lung injury and reassure parents until independent oral feeding is possible.
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11
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Kamity R, Ferrara L, Dumpa V, Reynolds J, Islam S, Hanna N. Simultaneous Videofluoroscopy and Endoscopy for Dysphagia Evaluation in Preterm Infants-A Pilot Study. Front Pediatr 2020; 8:537. [PMID: 33042904 PMCID: PMC7522365 DOI: 10.3389/fped.2020.00537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/27/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction: The assessment of dysphagia in preterm infants has been limited to clinical bedside evaluation followed by videofluoroscopic swallow study (VFSS) in selected patients. Recently, fiberoptic endoscopic evaluation of swallowing (FEES) is being described more in literature for preterm infants. However, it is unclear if one test has a better diagnostic utility than the other in this population. Furthermore, it is also unclear if performing FEES and VFSS simultaneously will increase the sensitivity and specificity of detecting dysphagia compared to either test performed independently. Objectives: The primary objective of this study is to evaluate the feasibility of performing VFSS and FEES simultaneously in preterm infants. Our secondary objective is to determine whether simultaneously performed VFSS-FEES improves the diagnostic ability in detecting dysphagia in preterm infants compared to either test done separately. Methods: In this pilot study, we describe the process involved in performing simultaneous VFSS-FEES in five preterm infants (postmenstrual age ≥36 weeks) with dysphagia. A total of 26 linked VFSS-FEES swallows were analyzed, where the same bolus during the same swallow was compared using simultaneous fluoroscopy and endoscopy. The sensitivity and specificity of detecting penetration and aspiration were evaluated in simultaneous VFSS-FEES compared with each test done independently. Results: Our results demonstrated that performing simultaneous VFSS-FEES is feasible in preterm infants with dysphagia. All patients tolerated the procedures well without any complications. Our pilot study in these five symptomatic preterm infants demonstrated a low incidence of aspiration but a high incidence of penetration. Simultaneous VFSS-FEES (26 linked swallows) improved the ability to detect penetration compared to each test done separately. Conclusion: To our knowledge, this study is the first to demonstrate the feasibility of performing VFSS and FEES simultaneously in symptomatic preterm infants with dysphagia resulting in potentially higher diagnostic yield than either procedure done separately.
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Affiliation(s)
- Ranjith Kamity
- Department of Pediatrics, New York University Winthrop Hospital, Mineola, NY, United States.,Department of Pediatrics, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Louisa Ferrara
- Department of Pediatrics, New York University Winthrop Hospital, Mineola, NY, United States.,Department of Communication Sciences and Disorders, Molloy College, Rockville Centre, NY, United States
| | - Vikramaditya Dumpa
- Department of Pediatrics, New York University Winthrop Hospital, Mineola, NY, United States.,Department of Pediatrics, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Jenny Reynolds
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, United States
| | - Shahidul Islam
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Nazeeh Hanna
- Department of Pediatrics, New York University Winthrop Hospital, Mineola, NY, United States.,Department of Pediatrics, New York University Long Island School of Medicine, Mineola, NY, United States
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12
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The effects of oral feeding while on nasal continuous positive airway pressure (NCPAP) in preterm infants. J Perinatol 2020; 40:909-915. [PMID: 32086439 PMCID: PMC7224016 DOI: 10.1038/s41372-020-0632-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether delaying oral feeding until coming off NCPAP will alter feeding and respiratory-related morbidities in preterm infants. DESIGN In this retrospective pre-post analysis, outcomes were compared in two preterm infant groups (≤32 weeks gestation). Infants in Group 1 were orally fed while on NCPAP, while infants in Group 2 were only allowed oral feedings after ceasing NCPAP. RESULTS Although infants in Group 2 started feeds at a later postmenstrual age (PMA), they reached full oral feeding at a similar PMA compared with Group 1. Interestingly, there was a positive correlation between the duration of oral feeding while on NCPAP and the time spent on respiratory support in Group 1. CONCLUSIONS Delayed oral feeding until ceasing NCPAP did not contribute to feeding-related morbidities. We recommend caution when initiating oral feedings in preterm infants on NCPAP without evaluating the safety of the infants and their readiness for oral feedings.
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Duncan DR, Mitchell PD, Larson K, McSweeney ME, Rosen RL. Association of Proton Pump Inhibitors With Hospitalization Risk in Children With Oropharyngeal Dysphagia. JAMA Otolaryngol Head Neck Surg 2019; 144:1116-1124. [PMID: 30325987 DOI: 10.1001/jamaoto.2018.1919] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Proton pump inhibitors (PPI) are commonly prescribed to children with oropharyngeal dysphagia and resultant aspiration based on the assumption that these patients are at greater risk for reflux-related lung disease. There is little data to support this approach and the potential risk for increased infections in children treated with PPI may outweigh any potential benefit. Objective The aim of this study was to determine if there is an association between hospitalization risk in pediatric patients with oropharyngeal dysphagia and treatment with PPI. Design, Setting, and Participants We performed a retrospective cohort study to compare the frequency and length of hospitalizations for children who had abnormal results on videofluoroscopic swallow studies that were performed between January 1, 2015, and December 31, 2015, and who were or were not treated with PPI, with follow-up through December 31, 2016. Records were reviewed for children who presented for care at Boston Children's Hospital, a tertiary referral center. Participants included 293 children 2 years and younger with evidence of aspiration or penetration on videofluoroscopic swallow study. Exposures Groups were compared based on their exposure to PPI treatment. Main Outcomes and Measures The primary outcomes were hospital admission rate and hospital admission nights and these were measured as incident rates. Multivariable analyses were performed to determine predictors of hospitalization risk after adjusting for comorbidities. Kaplan-Meier curves were created to determine the association of PPI prescribing with time until first hospitalization. Results A total of 293 patients with a mean (SD) age of 8.8 (0.4) months and a mean (SD) follow-up time of 18.15 (0.20) months were included in the analysis. Patients treated with PPI had higher admission rates (Incidence rate ratio [IRR], 1.77; 95% CI, 1.16-2.68) and admission nights (IRR, 2.51; 95% CI, 1.36-4.62) even after adjustment for comorbidities. Patients with enteral tubes who were prescribed PPIs were at the highest risk for admission (hazard ratio [HR], 2.31; 95% CI, 1.24-4.31). Conclusions and Relevance Children with aspiration who are treated with PPI have increased risk of hospitalization compared with untreated patients. These results support growing concern about the risks of PPI use in children.
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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, Massachusetts
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Maireade E McSweeney
- 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
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14
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Armstrong ES, Reynolds J, Carroll S, Sturdivant C, Suterwala MS. Comparing videofluoroscopy and endoscopy to assess swallowing in bottle-fed young infants in the neonatal intensive care unit. J Perinatol 2019; 39:1249-1256. [PMID: 31332272 DOI: 10.1038/s41372-019-0438-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/20/2019] [Accepted: 05/31/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of videofluoroscopy (VFSS) and endoscopy (FEES) in detecting laryngeal penetration and tracheal aspiration in bottle-fed young infants in the NICU. STUDY DESIGN VFSS and FEES findings of 22 infants were compared to each other and to a composite reference standard in this prospective study. Sensitivity, specificity, positive and negative predictive values were calculated for each assessment. RESULT Agreement between VFSS and FEES was high (92%) for aspiration and moderate (56%) for penetration, with FEES detecting more instances of penetration. Compared to the composite reference standard, FEES had greater sensitivity and a higher negative predictive value for penetration than VFSS. Because of the low prevalence of aspiration, diagnostic accuracy could not be determined for aspiration for either assessment. CONCLUSION FEES appears to be more accurate in detecting penetration in this population, and both assessments are valuable tools in a comprehensive feeding and swallowing evaluation.
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Affiliation(s)
- Erika S Armstrong
- Department of Communication Sciences and Oral Health, Texas Woman's University, Denton, TX, USA
| | - Jenny Reynolds
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Sandra Carroll
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Chrysty Sturdivant
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Mustafa S Suterwala
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, TX, USA.
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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.
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National and regional trends in gastrostomy in very low birth weight infants in the USA: 2000-2012. J Perinatol 2018; 38:1270-1276. [PMID: 29925865 PMCID: PMC6195828 DOI: 10.1038/s41372-018-0145-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine rates of gastrostomy (GT) in very low birth weight (VLBW) infants. STUDY DESIGN Retrospective, cross-sectional analysis of the Kids' Inpatient Database for the years 2000, 2003, 2006, 2009 and 2012. We identified VLBW births and infants undergoing a GT, with and without fundoplication, using ICD-9-CM codes. RESULT National rates (per 1000 VLBW births) of GT increased from 11.5 GT (95% CI 10-13) in 2000 to 22.9 (95% CI 20-25) in 2012 (p < 0.001). Gastrostomy with and without fundoplication increased during the study period (p < 0.001 in both groups). VLBW survival also increased from 78.5% in 2000 to 81.1% in 2012 (p < 0.001). In all study years, the Northeast census region had the lowest GT rates, while the West had the highest rates in 4 of the 5 study years. CONCLUSION Between 2000 and 2012, the incidence of GT in VLBW infants doubled, associated with improvements in survival in this population.
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Prefeeding Oromotor Stimulation Program for Improving Oromotor Function in Preterm Infants — A Randomized Controlled Trial. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1357-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vetter-Laracy S, Osona B, Roca A, Peña-Zarza JA, Gil JA, Figuerola J. Neonatal swallowing assessment using fiberoptic endoscopic evaluation of swallowing (FEES). Pediatr Pulmonol 2018; 53:437-442. [PMID: 29356410 DOI: 10.1002/ppul.23946] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/04/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Swallowing disorders which lead to aspiration are common in premature infants with a postmenstrual age (PMA) of >36 weeks. Aspiration is often silent and the unique symptom is desaturation during feeding. The aim of this study was 1) to determine the number of prematures with desaturations during feeding due to aspiration, using Fiberoptic Endoscopic Evaluation of Swallowing (FEES); 2) to relate clinical factors and FEES findings to aspiration; and 3) to describe type and efficacy of suggested treatments. METHODS A retrospective review of 62 ex-premature babies with a median PMA of 40 weeks which underwent FEES due to persistent feeding desaturations. Aspiration was related to other FEES findings and to clinical and demographic data. The efficacy of the treatment was evaluated during the FEES and by comparing recorded desaturations during feeding 7 days before and after FEES. RESULTS A total of 44 (71%) infants were diagnosed with aspiration and/or penetration. No relation was found to demographic or clinical data. The accumulation of saliva and residues post-swallowing were related to aspiration (P < 0.01). In 77.3% of the infants, use of a thickener seemed to reduce aspiration during FEES and was suggested as a treatment. 13.6% of infants received anti-reflux treatment after FEES and 9.1% required gastrostomy. CONCLUSIONS Aspiration is very frequent in premature infants who present desaturations during feeding and FEES is a useful method for diagnosing and suggesting treatments.
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Affiliation(s)
- Susanne Vetter-Laracy
- Division of Neonatology, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Borja Osona
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Antonia Roca
- Division of Neonatology, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Jose A Peña-Zarza
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Jose A Gil
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Joan Figuerola
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
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Ferrara L, Kamity R, Islam S, Sher I, Barlev D, Wennerholm L, Redstone F, Hanna N. Short-Term Effects of Cold Liquids on the Pharyngeal Swallow in Preterm Infants with Dysphagia: A Pilot Study. Dysphagia 2018; 33:593-601. [PMID: 29435661 DOI: 10.1007/s00455-018-9877-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 01/23/2018] [Indexed: 12/22/2022]
Abstract
Cold stimulation reduces airway compromise in adults with dysphagia. However, there is no sufficient evidence to support its use in the pediatric population. The primary goal of this pilot study is to assess the effect of cold liquid on the pharyngeal swallow mechanism in preterm infants with dysphagia. We hypothesized that thermal stimulation from cold liquid will decrease the risk of airway compromise in dysphagic preterm infants. Nine preterm infants with clinical symptoms of dysphagia were included. Video fluoroscopic swallow studies were used to assess the swallowing mechanism of each participant. The occurrence of swallow dysfunctions under room temperature liquid swallows (RTS) vs. short period cold liquid swallows (CS) was compared. Paired t test was used to test significance. The occurrence of deep penetration (p = 0.007) and aspiration (p = 0.002) decreased significantly in the CS condition compared with the RTS condition. There was a trend of less nasopharyngeal reflux with CS but did not reach statistical significance (p = 0.084). No differences were noted for mild penetration (p = 0.824). CS reduced airway compromise in dysphagic preterm infants compared to RTS. These data provide important information regarding the immediate effects of CS on pharyngeal swallowing in preterm infants with dysphagia. However, further investigation regarding its sustained effects is required before introducing to clinical practice.
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Affiliation(s)
- Louisa Ferrara
- Children's Medical Center, NYU-Winthrop Hospital, 259 1st Street, Mineola Blvd., Mineola, NY, 11501, USA
| | - Ranjith Kamity
- Division of Neonatology, Children's Medical Center, NYU-Winthrop Hospital, 259 1st Street Mineola Blvd, Mineola, NY, 11501, USA
| | - Shahidul Islam
- Children's Medical Center, NYU-Winthrop Hospital, 259 1st Street, Mineola Blvd., Mineola, NY, 11501, USA
| | - Irene Sher
- Children's Medical Center, NYU-Winthrop Hospital, 259 1st Street, Mineola Blvd., Mineola, NY, 11501, USA
| | - Dan Barlev
- Children's Medical Center, NYU-Winthrop Hospital, 259 1st Street, Mineola Blvd., Mineola, NY, 11501, USA
| | - Laurie Wennerholm
- White Plains Hospital, 41 Eat Post Road, White Plains, NY, 10601, USA
| | - Fran Redstone
- Adelphi University, 158 Cambridge Ave, Garden City, NY, 11530, USA
| | - Nazeeh Hanna
- Division of Neonatology, Children's Medical Center, NYU-Winthrop Hospital, 259 1st Street Mineola Blvd, Mineola, NY, 11501, USA.
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Harding C, Cockerill H, Cane C, Law J. Using non-nutritive sucking to support feeding development for premature infants: A commentary on approaches and current practice. J Pediatr Rehabil Med 2018; 11:147-152. [PMID: 29125505 DOI: 10.3233/prm-170442] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Non-nutritive sucking is often used with premature infants by either using a pacifier or an expressed breast nipple to support the introduction and development of early oral feeding. The pattern of non-nutritive sucking is distinct in that it involves two sucks per second in contrast to nutritive sucking which is one suck per second. Although some literature has identified that non-nutritive sucking has some benefit for the premature infant's feeding development, it is not entirely clear why such an approach is helpful as neurologically, activation of non-nutritive and nutritive skills are different. A summary is presented of the main approaches that use non-nutritive sucking with reference to the literature. This paper also considers other factors and beneficial approaches to managing the introduction of infant feeding. These are: the infant's toleration of enteral feeds pre oral trials, overall development and gestational age when introducing oral experiences, developing swallowing skills before sucking, physiological stability, health status, as well as the development and interpretation of infant oral readiness signs and early communication.
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Affiliation(s)
- C Harding
- Division of Language and Communication Sciences, City, University of London, London, UK
| | - H Cockerill
- Evelina Children's Hospital, Guy's and St. Thomas's NHS Trust, London, UK
| | - C Cane
- Starlight Neonatal Unit, Barnet Hospital, Royal Free NHS Foundation Hospitals Trust, London, UK
| | - J Law
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle, UK
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Lee KM, Seo YT. Development of a Dysphagia Screening Test for Preterm Infants (DST-PI). Ann Rehabil Med 2017; 41:434-440. [PMID: 28758081 PMCID: PMC5532349 DOI: 10.5535/arm.2017.41.3.434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/10/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore both the early prediction and diagnosis of dysphagia in preterm infants as an important developmental aspect as well as the prevention of respiratory complications, we developed the simple and-easy-to-apply Dysphagia Screening Test for Preterm Infants (DST-PI) to predict supraglottic penetration and subglottic aspiration. METHODS Fifty-two infants were enrolled in a videofluoroscopic swallowing study (VFSS) due to clinical suspicions of dysphagia. Thirteen items related to supraglottic penetration or subglottic aspiration were initially selected from previous studies for the DST-PI. Finally, 7 items were determined by linear logistic regression analysis. Cutoff values, sensitivity, specificity, and the area under the ROC curve (AUC) of the DST-PI for predicting supraglottic penetration or subglottic aspiration were calculated using a ROC curve. For inter-rater reliability, the kappa coefficient was calculated. RESULTS Seven items were selected: 'gestational age,' 'history of apnea,' 'history of cyanosis during feeding,' 'swallowing pattern,' 'coughs during or after feeding,' 'decreased oxygen saturation within 3 minutes of feeding,' and 'voice change after feeding.' The Spearman correlation coefficient between the DST-PI and the penetration-aspiration scale (PAS) was 0.807 (p<0.001). The sensitivity and specificity at different cutoff values for detecting supraglottic penetration and subglottic aspiration were 96.6% and 76.9% at 3.25, and 88.9% and 75.8% at 6.25, respectively. CONCLUSION The DST-PI is a valid and reliable dysphagia screening test for supraglottic penetration or subglottic aspiration in preterm infants that is easy to apply in a clinical context.
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Affiliation(s)
- Kyoung Moo Lee
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Young Tak Seo
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
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Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates. J Perinatol 2017; 37:398-403. [PMID: 28055023 DOI: 10.1038/jp.2016.229] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/18/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Feeding neonates orally while on nasal continuous positive airway pressure (nCPAP) is a common practice. We hypothesize that pressurized airflow provided by nCPAP will alter the swallowing mechanism in neonates, increasing the risk of aspiration during oral feeding. STUDY DESIGN Infants receiving nCPAP with a RAM cannula and tolerating at least 50% of their feeding orally were included in the study (one term; six preterm infants). Each participant underwent a videofluoroscopic swallow study while on nCPAP and off nCPAP. A non-parametric signed-rank test was used for paired data. RESULT The incidence of deep penetration (P=0.03) and aspiration (P=0.01) decreased significantly off-nCPAP compared with on-nCPAP. However, the incidence of mild penetration (P=0.65) and nasopharyngeal reflux (P=0.87) remained the same under both conditions. CONCLUSION Oral feeding while on-nCPAP significantly increases the risk of laryngeal penetration and tracheal aspiration events. We recommend caution when initiating oral feedings on nCPAP.
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Yamamoto RCDC, Prade LS, Bolzan GDP, Weinmann ARM, Keske-Soares M. Relationship between oxygen saturation, gestational age, and level of oral feeding skills in preterm infants. Codas 2017; 29:e20150219. [PMID: 28300951 DOI: 10.1590/2317-1782/20172015219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/14/2015] [Indexed: 11/21/2022] Open
Abstract
Purpose To correlate the peripheral oxygen saturation with gestational age and the level of oral feeding skills in the introduction of oral feeding in preterm infants. Methods This is a cross-sectional, quantitative study whose sample was composed of 169 clinically stable preterm infants. Peripheral oxygen saturation was assessed before and after introduction of oral feeding. The preterm infants were stratified into three groups based on their gestational age at birth: 26-29, 30-33, and 34-36 weeks. The preterm infants were classified into four levels according to their oral feeding skill and resistance. Results No differences in oxygen saturation were observed between the strata of gestational age and between the levels of oral feeding skill. Differences were observed in the groups of preterm infants aged 30-33 weeks (p=0.04) and 34-36 weeks (p=0.02) and on the level I of oral feeding skills (p=0.04) when oxygen saturation was compared at pre- and post-first oral feeding. Significant correlations (p<0.001) were found between gestational age and the levels of oral feeding skills (r=0.38); in Group A, between gestational age and oxygen saturation before the first oral feeding (r=0.83); in Group B, between the level of oral feeding skill and oxygen saturation before the first oral feeding (r=0.26) and between level of oral feeding skill and gestational age (r=0.26). Conclusion Correlation was found for peripheral oxygen saturation when compared with gestational age and with the level of oral feeding skills.
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Affiliation(s)
| | - Leila Sauer Prade
- Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil
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Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia. J Pediatr 2017; 181:12-28.e1. [PMID: 27908648 PMCID: PMC5562402 DOI: 10.1016/j.jpeds.2016.10.082] [Citation(s) in RCA: 245] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/20/2016] [Accepted: 10/26/2016] [Indexed: 01/02/2023]
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Tian X, Yi LJ, Zhang L, Zhou JG, Ma L, Ou YX, Shuai T, Zeng Z, Song GM. Oral Motor Intervention Improved the Oral Feeding in Preterm Infants: Evidence Based on a Meta-Analysis With Trial Sequential Analysis. Medicine (Baltimore) 2015; 94:e1310. [PMID: 26252313 PMCID: PMC4616601 DOI: 10.1097/md.0000000000001310] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Oral feeding for preterm infants has been a thorny problem worldwide. To improve the efficacy of oral feeding in preterm infants, oral motor intervention (OMI), which consists of nonnutritive sucking, oral stimulation, and oral support, was developed. Published studies demonstrated that OMI may be as an alternative treatment to solve this problem; however, these results remain controversial. We conducted a meta-analysis with trial sequential analysis (TSA) to objectively evaluate the potential of OMI for improving the current status of oral feeding in preterm infants.A search of PubMed, EMBASE, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure was performed to capture relevant citations until at the end of October, 2014. Lists of references of eligible studies and reviews were also hand-checked to include any latent studies. Two independent investigators screened literature, extracted data, and assessed the methodology, and then a meta-analysis and TSA was performed by using Reviewer Manager (RevMan) 5.3 and TSA 0.9 beta, respectively.A total of 11 randomized controlled trials (RCTs), which included 855 participants, were incorporated into our meta-analysis. The meta-analyses suggested that OMI is associated with the reduced transition time (ie, the time needed from tube feeding to totally oral feeding) (mean difference [MD], -4.03; 95% confidence interval [CI], -5.22 to -2.84), shorten hospital stays (MD, -3.64; 95% CI, -5.57 to -1.71), increased feeding efficiency (MD, 0.08; 95% CI, 0.36-1.27), and intake of milk (MD, 0.14; 95% CI, 0.06-0.21) rather than weight gain. Results of TSA for each outcomes of interest confirmed these pooled results.With present evidences, OMI can be as an alternative to improve the condition of transition time, length of hospital stays, feeding efficiency, and intake of milk in preterm infants. However, the pooled results may be impaired due to low quality included, and thus, well-designed and large RCTs were needed to further established effects.
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Affiliation(s)
- Xu Tian
- From the Graduate College (XT, L-JY, LZ, LM, Y-XO), Tianjin University of Traditional Chinese Medicine, Tianjin; School of Nursing (XT, L-JY, LZ, LM, TS, ZZ), Tianjin University of Traditional Chinese Medicine, Tianjin; Department of Oncology (J-GZ), Affiliated Hospital to Zunyi Medical University, Zunyi; College of TCM (Y-XO), Tianjin University of Traditional Chinese Medicine, Tianjin; and Department of Nursing (G-MS), Tianjin Hospital, Tianjin, China
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Bae SO, Lee GP, Seo HG, Oh BM, Han TR. Clinical characteristics associated with aspiration or penetration in children with swallowing problem. Ann Rehabil Med 2014; 38:734-41. [PMID: 25566471 PMCID: PMC4280368 DOI: 10.5535/arm.2014.38.6.734] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/01/2014] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate demographic characteristics of children with suspected dysphagia who underwent videofluoroscopic swallowing study (VFSS) and to identify factors related to penetration or aspiration. Methods Medical records of 352 children (197 boys, 155 girls) with suspected dysphagia who were referred for VFSS were reviewed retrospectively. Clinical characteristics and VFSS findings were analyzed using univariate and multivariate analyses. Results Almost half of the subjects (n=175, 49%) were under 24 months of age with 62 subjects (18%) born prematurely. The most common condition associated with suspected dysphagia was central nervous system (CNS) disease. Seizure was the most common CNS disorder in children of 6 months old or younger. Brain tumor was the most important one for school-age children. Aspiration symptoms or signs were the major cause of referral for VFSS in children except for infants of 6 months old or where half of the subjects showed poor oral intake. Penetration or aspiration was observed in 206 of 352 children (59%). Subjects under two years of age who were born prematurely at less than 34 weeks of gestation were significantly (p=0.026) more likely to show penetration or aspiration. Subjects with congenital disorder with swallow-related anatomical abnormalities had a higher percentage of penetration or aspiration with marginal statistical significance (p=0.074). Multivariate logistic regression analysis revealed that age under 24 months and an unclear etiology for dysphagia were factors associated with penetration or aspiration. Conclusion Subjects with dysphagia in age group under 24 months with preterm history and unclear etiology for dysphagia may require VFSS. The most common condition associated with dysphagia in children was CNS disease.
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Affiliation(s)
- Soon Ook Bae
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Gang Pyo Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Singendonk MMJ, Rommel N, Omari TI, Benninga MA, van Wijk MP. Upper gastrointestinal motility: prenatal development and problems in infancy. Nat Rev Gastroenterol Hepatol 2014; 11:545-55. [PMID: 24890279 DOI: 10.1038/nrgastro.2014.75] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Deglutition, or swallowing, refers to the process of propulsion of a food bolus from the mouth into the stomach and involves the highly coordinated interplay of swallowing and breathing. At 34 weeks gestational age most neonates are capable of successful oral feeding if born at this time; however, the maturation of respiration is still in progress at this stage. Infants can experience congenital and developmental pharyngeal and/or gastrointestinal motility disorders, which might manifest clinically as gastro-oesophageal reflux (GER) symptoms, feeding difficulties and/or refusal, choking episodes and airway changes secondary to micro or overt aspiration. These problems might lead to impaired nutritional intake and failure to thrive. These gastrointestinal motility disorders are mostly classified according to the phase of swallowing in which they occur, that is, the oral preparatory, oral, pharyngeal and oesophageal phases. GER is a common phenomenon in infancy and is referred to as GERD when it causes troublesome complications. GER is predominantly caused by transient relaxation of the lower oesophageal sphincter. In oesophageal atresia, oesophageal motility disorders develop in almost all patients after surgery; however, a congenital origin of disordered motility has also been proposed. This Review highlights the prenatal development of upper gastrointestinal motility and describes the most common motility disorders that occur in early infancy.
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Affiliation(s)
- Maartje M J Singendonk
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Nathalie Rommel
- Department of Neurosciences, ExpORL, KU Leuven, O&N II Herenstraat 49, Box 721, 3000 Leuven, Belgium
| | - Taher I Omari
- Gastroenterology Unit, Women's and Children's Health Network, 72 King William Street, 5006 SA, Australia
| | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Michiel P van Wijk
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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McGrath-Morrow SA, Hayashi M, Aherrera AD, Collaco JM. Respiratory outcomes of children with BPD and gastrostomy tubes during the first 2 years of life. Pediatr Pulmonol 2014; 49:537-43. [PMID: 24039081 PMCID: PMC4088273 DOI: 10.1002/ppul.22870] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/21/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Infants with bronchopulmonary dysplasia (BPD) often undergo gastrostomy tube (GT) placement and/or Nissen fundoplication (Nissen) to improve weight gain and to attenuate chronic respiratory symptoms related to feeding difficulties. After initial hospitalization little is known how these children do with regard to respiratory symptoms when compared to children with BPD who did not receive GTs. This study was done to determine if differences in respiratory outcomes were associated with the presence of a GT or Nissen/GT in children with BPD during the first 2 years of life. METHODS Children (n = 398) were recruited from the Johns Hopkins BPD Outpatient Clinic. Medical charts were reviewed and acute care usage and respiratory symptoms were assessed by caregiver questionnaires. RESULTS Ninety-two children with BPD had GTs, with the majority placed by 6 months of age. Of children with GTs, 64.7% also had Nissen fundoplication. Children with Nissen/GTs were more likely to have birth weights <10th percentile and to be discharged on supplemental oxygen. After initial hospitalization, children with GTs and Nissen/GTs weaned off supplemental oxygen at significantly older ages than children without GTs. Children with Nissen/GTs also had more hospitalizations than children without GTs. Caregivers of children with GTs and Nissen/GTs reported similar respiratory symptoms as caregivers of children without GTs. CONCLUSION Weaning off supplemental oxygen occurred later in children with GTs and Nissen/GTs compared to children without GTs. Although children with Nissen/GTs had more re-hospitalizations, there were no differences in reported respiratory symptoms between any of the groups by caregiver questionnaire.
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Affiliation(s)
- Sharon A McGrath-Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Feeding immaturity in preterm neonates: risk factors for oropharyngeal aspiration and timing of maturation. J Pediatr Gastroenterol Nutr 2013; 57:735-40. [PMID: 23969537 DOI: 10.1097/mpg.0b013e3182a9392d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Oropharyngeal aspiration (OPA) is a common cause of morbidity in premature neonates. We sought to identify significant risk factors and determine the timing of feeding maturation in preterm infants with OPA. METHODS We performed a retrospective medical record review of 148 former preterm neonates referred for modified barium swallow study (MBSS) during a 3-year period. We looked at the MBSS results and potential clinical and demographic risk factors and performed bivariate and multivariable logistic regression analyses to evaluate predictors of failure. We evaluated the timing of resolution of OPA based on MBSS results. RESULTS Of the 148 infants comprising our study cohort, 47 (32%) passed their initial MBSS and 101 (68%) were found to aspirate thin liquids. Infants who aspirate had younger corrected gestational age (CGA) and postnatal age at the time of testing. Increasing CGA led to lower odds of failing. Infants passed a MBSS at a median CGA of 53 weeks and those who failed an initial MBSS eventually passed after a median of ∼3.4 months from the first study. Infants with bronchopulmonary dysplasia had lower odds of failing their MBSS (odds ratio 0.16), but those taking inhaled corticosteroids and diuretics had higher odds of failing, and infants who were multiples also had higher odds of failing. CONCLUSIONS We determined the median CGA for passing MBSS and identified risk factors for OPA in this population. This information can help guide providers when counseling families on timing of feeding maturity and anticipation of appropriate timing for follow-up MBSS testing.
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Uhm KE, Yi SH, Chang HJ, Cheon HJ, Kwon JY. Videofluoroscopic swallowing study findings in full-term and preterm infants with Dysphagia. Ann Rehabil Med 2013; 37:175-82. [PMID: 23705111 PMCID: PMC3660477 DOI: 10.5535/arm.2013.37.2.175] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 09/08/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the clinical characteristics and videofluoroscopic swallowing study (VFSS) findings in infants with suspected dysphagia and compare the clinical characteristics and VFSS findings between full-term and preterm infants. METHODS A total of 107 infants (67 full-term and 40 preterm) with suspected dysphagia who were referred for VFSS at a tertiary university hospital were enrolled in this retrospective study. Clinical characteristics and VFSS findings were reviewed by a physiatrist and an experienced speech-language pathologist. The association between the reasons of referral for VFSS and VFSS findings were analyzed. RESULTS Mean gestational age was 35.1±5.3 weeks, and mean birth weight was 2,381±1,026 g. The most common reason for VFSS referral was 'poor sucking' in full-term infants and 'desaturation' in preterm infants. The most common associated medical condition was 'congenital heart disease' in full-term infants and 'bronchopulmonary dysplasia' in preterm infants. Aspiration was observed in 42 infants (39.3%) and coughing was the only clinical predictor of aspiration in VFSS. However, 34 of 42 infants (81.0%) who showed aspiration exhibited silent aspiration during VFSS. There were no significant differences in the VFSS findings between the full-term and preterm infants except for 'decreased sustained sucking.' CONCLUSION There are some differences in the clinical manifestations and VFSS findings between full-term and preterm infants with suspected dysphagia. The present findings provide a better understanding of these differences and can help clarify the different pathophysiologic mechanisms of dysphagia in infants.
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Affiliation(s)
- Kyeong Eun Uhm
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Boudaa N, Samson N, Carrière V, Germim PS, Pasquier JC, Bairam A, Praud JP. Effects of caffeine and/or nasal CPAP treatment on laryngeal chemoreflexes in preterm lambs. J Appl Physiol (1985) 2013; 114:637-46. [PMID: 23305977 DOI: 10.1152/japplphysiol.00599.2012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Current knowledge suggests that laryngeal chemoreflexes (LCR) are involved in the occurrence of certain neonatal apneas/bradycardias, especially in the preterm newborn. While caffeine and/or nasal continuous positive airway pressure (nCPAP) are the most frequent options used for treating apneas in preterm newborns, their effects on LCR-related apneas/bradycardias are virtually unknown. The aim of the present study was to test the hypothesis that caffeine and/or nCPAP decreases LCR-related cardiorespiratory inhibition in a preterm ovine model. Seven preterm lambs were born vaginally on gestational day 133 (normal gestation: 147 days) after intramuscular injections of betamethasone and mifepristone. Five days after birth, a chronic surgical instrumentation was performed to record states of alertness, electrocardiogram, systemic arterial pressure, and electromyographic activity of a laryngeal constrictor muscle, as well as to insert a transcutaneous supraglottal catheter. LCR were induced in quiet sleep under four conditions: 1) control (without caffeine or nCPAP); 2) nCPAP (5 cmH2O, without caffeine); 3) caffeine (10 mg/kg infused intravenously for 30 min, without nCPAP); and 4) nCPAP + caffeine. Our results showed that nCPAP consistently blunted LCR-related cardiorespiratory inhibition vs. control condition, contrary to caffeine whose overall effect was nonsignificant. In addition, nCPAP condition was characterized by a more consistent and rapid arousal after HCl injection. No significant differences were observed between all tested conditions with regard to swallowing and cough. It is concluded that nCPAP should be further assessed for its usefulness in treating neonatal apneas linked to LCR.
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Affiliation(s)
- Nadia Boudaa
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Physiology, Université de Sherbrooke, Quebec, Canada J1H 5N4
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Chang YS, Park WS. Strategies to Overcome the Limit of Viability of Microprimie. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.3.258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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