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Cron AC, David M, Orbell-Smith J, Chang AB, Weir KA, Frakking TT. Cervical Auscultation for Detecting Oropharyngeal Aspiration in Paediatric and Adult Populations: A Systematic Review and Meta-Analysis. Clin Otolaryngol 2024; 49:713-724. [PMID: 39115253 DOI: 10.1111/coa.14202] [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: 12/13/2023] [Revised: 03/12/2024] [Accepted: 06/29/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND Cervical auscultation (CA) involves listening to swallowing and respiratory sounds and/or vibrations to detect oropharyngeal aspiration (OPA). CA has shown promising diagnostic test accuracy when used with the clinical swallowing examination and is gaining popularity in clinical practise. There has not been a review to date analysing the accuracy of CA in paediatric and adult populations with meta-analyses. OBJECTIVES To determine the accuracy of CA in detecting OPA in paediatric and adult populations, when compared to instrumental assessments. SEARCH METHODS Databases searched included MEDLINE, PubMed, Embase, CINAHL, AustHealth, Cochrane and Web of Science. The search was restricted between 01 October 2012 and 01 October 2022. SELECTION CRITERIA Inclusion criteria included (a) all clinical populations of all ages, (b) who have had an instrumental assessment and (c) CA. All study types were included. DATA COLLECTION AND ANALYSIS Studies were reviewed independently by two authors. The methodological quality of the studies was analysed using the QUADAS-2. MAIN RESULTS Ten studies met the inclusion criteria for this review and meta-analyses. The pooled diagnostic performance of CA in detecting OPA was 0.91 for sensitivity and 0.79 for specificity. The area under the curve summary receiver operating curve (sROC) was estimated to be 0.86, thereby indicating good discrimination of OPA. Most studies scored high for risk of bias in at least one domain in the QUADAS-2, likely attributed to a lack of high-quality prospectively designed studies. CONCLUSIONS There are promising diagnostic test accuracies for the use of CA in detection of OPA. Future research could include using CA in specific clinical populations and settings, and identifying standardised criteria for CA.
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Affiliation(s)
- Annelise C Cron
- Centre for Clinical Research, School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council, Sydney, New South Wales, Australia
| | - Jane Orbell-Smith
- Education Unit, Caboolture Hospital, Metro North Hospital & Health Service, Caboolture, Queensland, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, South Brisbane, Queensland, Australia
| | - Kelly A Weir
- Audiology & Speech Pathology, Division of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Speech Pathology Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Thuy T Frakking
- Centre for Clinical Research, School of Medicine, The University of Queensland, Herston, Queensland, Australia
- Research Development Unit, Caboolture Hospital, Metro North Hospital & Health Service, Caboolture, Queensland, Australia
- Speech Pathology Department, Gold Coast University Hospital, Gold Coast Hospital & Health Service, Southport, Queensland, Australia
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Duncan DR, Golden C, Growdon AS, Larson K, Rosen RL. Brief Resolved Unexplained Events Symptoms Frequently Result in Inappropriate Gastrointestinal Diagnoses and Treatment. J Pediatr 2024; 272:114128. [PMID: 38815745 PMCID: PMC11347082 DOI: 10.1016/j.jpeds.2024.114128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/19/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To determine associations between presenting symptoms and oropharyngeal dysphagia diagnoses, gastroesophageal reflux disease (GERD) diagnoses, and treatment with acid suppression medication in infants with brief resolved unexplained event (BRUE). STUDY DESIGN We performed a prospective cohort study of infants with BRUE to review presenting symptoms and their potential impact on testing and treatment. Videofluoroscopic swallow study (VFSS) results and explanatory diagnoses were obtained from medical record review; acid suppression use was determined by parental survey. Binary and multivariable logistic regression models were used to evaluate associations between presenting symptoms and obtaining VFSS, VFSS results, GERD diagnoses, and acid suppression medication. RESULTS Presenting symptoms were varied in 157 subjects enrolled at 51.0 ± 5.3 days of age, with many symptoms that may be related to GERD or dysphagia. Of these, 28% underwent VFSS with 71% abnormal. Overall, 42% had their BRUE attributed to GERD, and 33% were treated with acid suppression during follow-up. Presenting symptoms were significantly associated with the decision to obtain VFSS but not with abnormal VFSS results. Presenting symptoms were also associated with provision of GERD explanatory diagnoses. Both presenting symptoms and GERD explanatory diagnoses were associated with acid suppression use (aOR 2.3, 95% CI 1.03-5.3, P = .04). CONCLUSIONS Presenting symptoms may play a role in clinicians' decisions on which BRUE patients undergo VFSS but are unreliable to make a diagnosis of oropharyngeal dysphagia. Presenting symptoms may also influence assignment of GERD explanatory diagnoses that is associated with increased acid suppression medication use.
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Affiliation(s)
- Daniel R Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.
| | - Clare Golden
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
| | - Amanda S Growdon
- Division of General Pediatrics, Hospital Medicine Program, Boston Children's Hospital, Boston, MA
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
| | - Rachel L Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
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D'Angelo EC. Clinical Feeding and Swallowing Evaluation for the School-Based Speech-Language Pathologist. Lang Speech Hear Serv Sch 2024; 55:409-422. [PMID: 38029415 DOI: 10.1044/2023_lshss-23-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
PURPOSE From preschool through high school, eating is part of the school day. Children with feeding and/or swallowing issues are now in our neighborhood schools, our responsibility in our care, and require adequate nutrition and hydration to participate in school and access the curriculum. The whole child is in school, including all of their medical, behavioral, social, and educational needs. This clinical focus article describes a holistic process of evaluating swallowing and feeding in the school setting for the school speech-language pathologist (SLP) leading the team supporting the child. METHOD This clinical focus article explores the evaluation process in the educational setting for the school SLP in identification of pediatric feeding disorders (PFDs), which can involve dysphagia. Detailed descriptions of the related U.S. educational law, PFD, assessment processes for the multiple systems relating to eating, and collaboration with an interdisciplinary team are highlighted. Using the four overlapping domains of PFD (medical, psychosocial, feeding skill-based systems and associated nutritional aspects), medical and background history gathering; integration with instrumental results; and the need to consider the complex interaction of developmental, physical, cognitive, social, behavioral, family, and cultural aspects in the evaluation are detailed. CONCLUSIONS School-age children require safe and adequate nutrition and hydration for learning and social participation. The SLP has a lead role in the school team in evaluating swallowing and feeding, and developing a plan for team implementation. A holistic school-based SLP clinical evaluation process is described.
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Affiliation(s)
- Elisabeth C D'Angelo
- Department of Communication Sciences & Disorders, California State University, Sacramento
- Davis Joint Unified School District, CA
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West KM. Treating Pediatric Feeding Disorders and Dysphagia: Evidence-Based Interventions for School-Based Clinicians. Lang Speech Hear Serv Sch 2024; 55:444-457. [PMID: 38198285 DOI: 10.1044/2023_lshss-23-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
PURPOSE Children with pediatric feeding disorder (PFD) and dysphagia are increasingly prevalent in school-based caseloads. This tutorial discusses the current best practices for treating children with PFD and dysphagia as well as considerations for service delivery in educational settings. METHOD The rationale for treating PFD and dysphagia in an educational setting is discussed. A review of various interventions for PFD and dysphagia and a discussion of the available evidence are provided. The principles of experience-dependent neuroplasticity and theory-driven practice are discussed in light of the need for additional empirical research. Practical considerations to enhance evidence-based practice for PFD and dysphagia in educational settings are explored. RESULTS The reader will be able to identify evidence-based interventions for students with PFD and dysphagia and plan for the implementation of these approaches in the school setting. CONCLUSIONS Students with PFD and dysphagia require skilled interventions to support their participation in educationally relevant activities and to promote continued development of feeding and swallowing skills while at school. A discussion of the current evidence for various interventions is provided to promote the utilization of evidence-based interventions in school-based settings.
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Affiliation(s)
- Kristen M West
- Department of Communication Sciences and Disorders, Pennsylvania Western University Edinboro, PA
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Duncan DR, Golden C, Larson K, Williams N, Simoneau T, Rosen RL. Breastfeeding in infants who aspirate may increase risk of pulmonary inflammation. Pediatr Pulmonol 2024; 59:600-608. [PMID: 38038162 PMCID: PMC10922248 DOI: 10.1002/ppul.26788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/24/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To evaluate management strategies and pulmonary outcomes for breastfed infants with oropharyngeal dysphagia. STUDY DESIGN We performed a retrospective cohort study of breastfed infants diagnosed with oropharyngeal dysphagia with documented aspiration or laryngeal penetration on videofluoroscopic swallow study (VFSS). Medical records were reviewed for VFSS results and speech-language pathologist recommendations following VFSS, results of chest x-ray, results of bronchoalveolar lavage (BAL) within 1 year of VFSS, and aspiration-related hospitalizations occurring before or within 1 year of VFSS. Subjects were categorized as cleared or not cleared to breastfeed based on the VFSS. Proportions were compared with Chi-square and Fisher's exact tests and means with Student's t-tests. RESULTS Seventy-six infants (4.7 ± 0.4 months old) were included; 50% (38) had aspiration and 50% (38) had laryngeal penetration. After VFSS, 70% (53) were cleared to breastfeed while 30% (23) were not cleared to breastfeed. Patients with aspiration were less likely to be cleared to breastfeed (p = .006); however, 55% (21/38) of those with aspiration were still cleared to breastfeed. Infants cleared to breastfeed had significantly more pulmonary hospitalizations (p = .04) and were also at increased risk of elevated neutrophil count (p = .02) and culture growth on BAL (p = .01). Significantly increased abnormal neutrophil count was also found in those cleared to breastfeed with laryngeal penetration (p = .01). CONCLUSIONS Infants with oropharyngeal dysphagia counseled to continue breastfeeding had increased risk of BAL inflammation and more pulmonary hospitalizations compared to those that were told to stop breastfeeding.
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Affiliation(s)
- Daniel R. Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Clare Golden
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Nina Williams
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Tregony Simoneau
- Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA
| | - Rachel L. Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
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Miller AL, Miller CK, Fei L, Sun Q, Willging JP, de Alarcon A, Pentiuk SP. Predictive Value of Laryngeal Penetration to Aspiration in a Cohort of Pediatric Patients. Dysphagia 2024; 39:33-42. [PMID: 37243730 DOI: 10.1007/s00455-023-10589-8] [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: 10/24/2022] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
Videofluoroscopic swallow studies (VFSS) provide dynamic assessment of the phases of swallowing under fluoroscopic visualization and allow for identification of abnormalities in the process, such as laryngeal penetration and aspiration. While penetration and aspiration both reflect degrees of swallowing dysfunction, the predictive potential of penetration for subsequent aspiration is not fully elucidated in the pediatric population. As a result, management strategies for penetration vary widely. Some providers may interpret any depth or frequency of penetration as a proxy for aspiration and implement various therapeutic interventions (e.g., modification of liquid viscosity) to eliminate penetration episodes. Some may recommend enteral feeding given the presumed risk of aspiration with penetration, even when aspiration is not identified during the study. In contrast, other providers may advise continued oral feeding without modification even when some degree of laryngeal penetration is identified. We hypothesized that the depth of penetration is associated with the likelihood of aspiration. Identification of predictive factors for aspiration following laryngeal penetration events has significant implications for selection of appropriate interventions. We performed a retrospective cross-sectional analysis of a random sample of 97 patients who underwent VFSS in a single tertiary care center over a 6 month period. Demographic variables including primary diagnosis and comorbidities were analyzed. We examined the association between aspiration and degrees of laryngeal penetration (presence or absence, depth, frequency) across diagnostic categories. Infrequent and shallow penetration events of any type of viscosity were less likely to be associated with aspiration event(s) during the same clinical encounter regardless of diagnosis. In contrast, children with consistent deep penetration of thickened liquids invariably demonstrated aspiration during the same study. Our findings show that shallow, intermittent laryngeal penetration of any viscosity type on VFSS was not consistent with clinical aspiration. These results provide further evidence that penetration-aspiration is not a uniform clinical entity and that nuanced interpretation of videofluoroscopic swallowing findings is necessary to guide appropriate therapeutic interventions.
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Affiliation(s)
- Ashley L Miller
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Claire Kane Miller
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
- Division of Speech and Language Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Lin Fei
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Qin Sun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Paul Willging
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alessandro de Alarcon
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott P Pentiuk
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Young AE, Hinkes-Molinaro L, Ida J, Valika T, Ghadersohi S, Thompson DM, Hazkani I. Swallowing Function After Epiglottopexy in Children. Otolaryngol Head Neck Surg 2024; 170:560-567. [PMID: 37855629 DOI: 10.1002/ohn.556] [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: 05/18/2023] [Revised: 09/15/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Epiglottopexy has been an increasingly utilized intervention in children with epiglottic prolapse and airway obstruction. Given the role of the epiglottis in protecting the airway during swallowing and the potential effect of repositioning the epiglottis on the passage of the bolus, we aimed to compare swallowing outcomes before and after epiglottopexy in children. STUDY DESIGN A retrospective cohort study. SETTING Tertiary care children's hospital. METHODS Data were extracted from charts of children who underwent epiglottopexy and had a subsequent instrumental swallowing evaluation between January 2018 and September 2022. RESULTS A total of 93 patients underwent epiglottopexy. Of these, 38 patients met inclusion requirements. The mean age at surgery was 41 ± 47 months. Most patients (n = 37, 97.4%) had significant comorbidities such as secondary airway lesions (n = 33, 91.7%), a genetic or syndromic disorder (n = 25, 69.4%), and dysphagia (n = 29, 76.3%). All patients had a concurrent procedure at the time of epiglottopexy with supraglottoplasty (n = 24, 63.2%) and lingual tonsillectomy (n = 16, 42.1%) being the most common. No changes in initiation or patterns of swallowing were noted postoperatively. A total of 7 (18.4%) patients had worsening swallow function: 2 had new-onset dysphagia, and 5 had worsening pre-existing dysphagia. Liquid or food textures penetrated remained unchanged or improved in most cases. No risk factors for worsening dysphagia were identified in our cohort. CONCLUSION Children with medical comorbidities undergoing epiglottopexy with additional airway interventions may experience new or worsening dysphagia. However, the procedure is generally safe without notable patterned changes in the swallowing mechanism.
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Affiliation(s)
- Ashley E Young
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura Hinkes-Molinaro
- Department of Speech Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jonathan Ida
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Taher Valika
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Saied Ghadersohi
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dana M Thompson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Inbal Hazkani
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Pavić I, Karačić DE, Hojsak I. Bronchoalveolar lavage cytology in children with chronic unexplained cough and severely neurologically impaired children. Lab Med 2024; 55:20-26. [PMID: 37078851 DOI: 10.1093/labmed/lmad028] [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] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE We aimed to compare the cellular composition of bronchoalveolar lavage (BAL) fluids in children with chronic unexplained cough (group 1) and severely neurologically impaired children with chronic or recurrent respiratory problems (group 2) with the BAL cytology of children without pulmonary or systemic diseases (group 3). METHODS Bronchoscopy with BAL fluid analysis was performed in all subjects. Children with respiratory symptoms underwent 24-hour multichannel intraluminal impedance monitoring. RESULTS A significant difference was found between the groups in the total number of cells in BAL fluid cytology (191 [range, 24-12,747], 747 [range, 53-13,000], and 105 [range, 41-233] cells/μL, P = .015), in the percentage of neutrophils (21.2 [SD = 32.4], 49.4 [SD = 36.6], and 3.6 [SD = 2.4], P < .001), and in the percentage of lipid-laden macrophages (10.3 [SD = 11.4], 13.7 [SD = 15.8] and 0.44 [SD = 1.0], P < .001). CONCLUSION The BAL fluid cytology provides useful data for determining the cause of chronic unexplained cough and chronic or recurrent respiratory problems in severely neurologically impaired children.
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Affiliation(s)
- Ivan Pavić
- Departments of Pulmonology, Allergology and Immunology, Children's Hospital Zagreb, Zagreb, Croatia
- University of Split School of Medicine, Split, Croatia
| | | | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
- University J.J. Strossmayer School of Medicine Osijek, Osijek, Croatia
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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.
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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.
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10
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McGrattan KE, Hammell AE, Turski ME, Klein KE, Delaware E, McCormick J, Weikle E, Broderick E, Ramel SE, Mohr AH. Feeding characteristics of healthy infants without reported feeding impairments throughout the first month of life. J Perinatol 2024; 44:71-77. [PMID: 37700008 PMCID: PMC10783545 DOI: 10.1038/s41372-023-01760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 07/31/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE Elucidate characteristics of feeding performance in healthy infants without reported feeding problems throughout the first month of life. STUDY DESIGN Feeding was monitored in 61 healthy infants by caregiver report for 48 h a week from birth to 4 weeks old. Outcomes included feeding modality, how much they consumed, how long the feed lasted, and how many coughing episodes the infant exhibited. Data were analyzed with descriptive and non-parametric statistics. RESULT The majority of infants (68%) exhibited at least one problematic feeding behavior. Infants consumed 68 ml/feed over 20 min, though the milk volumes and feed durations were highly variable. Coughing occurred an average of 2 feeds per day. No significant change in coughing was observed throughout the first month of life (p = 0.64). Infants coughed significantly less during breast feeds than bottle feeds (p = 0.02). CONCLUSION Healthy term infants exhibit what appear to be normal developmental imperfections in feeding performance throughout the first month of life.
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Affiliation(s)
- Katlyn Elizabeth McGrattan
- Department of Speech Language and Hearing Science, University of Minnesota, Minneapolis, MN, USA.
- Department of Rehabilitation, Masonic Children's Hospital, Minneapolis, MN, USA.
| | - Abbey E Hammell
- Liberal Arts Technologies and Innovation Services (LATIS), University of Minnesota, Minneapolis, MN, USA
| | - Morgan Elaine Turski
- Department of Speech Language and Hearing Science, University of Minnesota, Minneapolis, MN, USA
| | - Kristina E Klein
- Department of Speech Language and Hearing Science, University of Minnesota, Minneapolis, MN, USA
| | - Elise Delaware
- Department of Speech Language and Hearing Science, University of Minnesota, Minneapolis, MN, USA
| | - Jennie McCormick
- Department of Speech Language and Hearing Science, University of Minnesota, Minneapolis, MN, USA
| | - Ellen Weikle
- Department of Speech Language and Hearing Science, University of Minnesota, Minneapolis, MN, USA
| | - Erin Broderick
- UC Health Department of Otolaryngology, University of Cincinnati, Cincinnati, OH, USA
| | - Sara E Ramel
- Department of Neonatology, University of Minnesota, Minneapolis, MN, USA
| | - Alicia Hofelich Mohr
- Liberal Arts Technologies and Innovation Services (LATIS), University of Minnesota, Minneapolis, MN, USA
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Malan R, Van Der Linde J, Kritzinger A, Graham MA, Krüger E, Kollapen K, Lockhat Z. Evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy during hospitalisation: A case series. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:893-902. [PMID: 36444930 DOI: 10.1080/17549507.2022.2147217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE To describe the evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy (HIE) during hospitalisation. METHOD A longitudinal cohort study was used. Twenty-nine participants (median age 39.0 weeks [IQR = 2.0 weeks]) with mild (n = 7), moderate (n = 19) and severe (n = 3) HIE were included. Clinical swallowing and feeding assessments were conducted at introduction of oral feeds and at discharge using the Neonatal Feeding Assessment Scale (NFAS). Videofluoroscopic swallow studies (VFSS) supplemented the NFAS before discharge. RESULT Approximately two thirds of participants showed symptoms of oropharyngeal dysphagia (OPD) during initial NFAS and VFSS. Significantly fewer OPD symptoms occurred at discharge NFAS (p = 0.004). Endurance during non-nutritive sucking (p < 0.001) and nutritive sucking (p < 0.001) significantly improved. Nine participants (31.0%) demonstrated penetration or aspiration. Most aspiration events were silent (60%). Instrumental assessment identified pharyngeal phase dysphagia more effectively than bedside evaluation. High proportions of participants displayed OPD symptoms regardless of HIE severity. The correlation between OPD severity and the length of hospitalisation (p = 0.052) was not significant. CONCLUSION All grades of HIE should be considered for early intervention by speech-language pathologists before discharge. Findings may be valuable to neonatal feeding teams.
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Affiliation(s)
- Roxanne Malan
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Jeannie Van Der Linde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Alta Kritzinger
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Marien A Graham
- Department of Science, Mathematics and Technology Education, University of Pretoria, Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Kumeshnie Kollapen
- Department of Radiology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Zarina Lockhat
- Department of Radiology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
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Smith JB, Kamarunas E, O'Donoghue C. The Influence of Side-Lying Position on Oropharyngeal Swallow Function in At-Risk Infants: An Exploratory Study. Clin Pediatr (Phila) 2023; 62:1087-1100. [PMID: 36919839 DOI: 10.1177/00099228231159158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
This investigation assessed the effect of side-lying position on infant oropharyngeal swallow physiology. Infant modified barium swallow studies (MBS) recordings were retrospectively examined in matched-pairs comparing at-risk infants swallowing in both an upright/cradled position and a side-lying position. Swallow parameters were measured independently and through a consensus coding approach. Infants fed in side-lying position showed a decrease in airway invasion severity as compared with when those same infants were fed in an upright/cradled position (P = .009). Bolus location at the time of swallow initiation was higher when infants were fed in side-lying position as compared with cradle position (P = .024), representing decreased risk of airway invasion. Infants fed in side-lying position demonstrated fewer swallows per breaths (P = .032). This pilot study validates the need for additional research to further define the mechanisms related to this improvement, and to determine how diagnosis and medical stability moderate these findings.
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Affiliation(s)
- Julian B Smith
- Department of Communication Disorders, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
- Speech-Language Pathology, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
| | - Cynthia O'Donoghue
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
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13
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Frakking TT, Whillans C, Rogash C, David M. Properties of Australian thickened formulae for infants and children: Influence of preparation and nutritional content on IDDSI properties. J Texture Stud 2023; 54:736-744. [PMID: 37086024 DOI: 10.1111/jtxs.12762] [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: 10/11/2022] [Revised: 03/03/2023] [Accepted: 04/08/2023] [Indexed: 04/23/2023]
Abstract
Between 30% and 50% of infants and children with pediatric feeding disorders demonstrate oropharyngeal aspiration. Thickening fluids are a compensatory strategy that is commonly recommended by speech pathologists for the management of oropharyngeal aspiration. Ongoing variability in the preparation of thickened fluids across infant formulas and healthcare facilities continue to limit the standardization of the preparation of thickened infant and pediatric formulas. No studies exist which examine the influence of nutritional properties of different infant formula types on IDDSI thickness levels. Our study aimed to describe the impact of standardized resting times; and understand the influence of nutritional properties on a variety of ready-to-feed liquid and powder-based Australian thickened formulae. A total of 27 ready-to-feed liquid and powder-based formulas were tested for viscosity level at baseline and when thickener was added on at least two trials. Frequency counts and percentages were used to describe categorical data. Logistic regression was used to model the binary outcome and calculate the odds ratios and their 95% confidence intervals. A total of 18 formulas proceeded to IDDSI flow testing of at least two trials because 7 formulae tested as slightly or mildly thick at baseline; while 2 formulae only had one trial of IDDSI flow testing completed. Of the 18 formulae tested, 72.22% (13/18) of commonly used powder-based and ready-to-feed formulas in Australia thickened to IDDSI slightly thick (level 1) were prepared in a standardized manner and allowed to rest for 5 min. Formulas with higher protein totals were more likely to thicken sufficiently (AOR: 7.45; 95% CI: 2.06-26.89), while formulas with higher sugar totals or those used for enteral feeds were less likely to thicken sufficiently (AOR: 0.02; 95% CI: 0.01-0.29). There was good test-retest reliability (ICC: 0.76; 95% CI: 0.22-0.97), indicating that standardizing the preparation of thickened fluids was consistently achievable. Given that not all formulae were observed to thicken to the intended consistency using standardized preparation and resting time, this study highlights the importance of using the IDDSI Flow Testing Method regularly in practice when recommending thickened infant formula recipes for managing aspiration in infants and children.
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Affiliation(s)
- Thuy T Frakking
- Speech Pathology Department, Gold Coast University Hospital, Southport, Australia
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14
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Chou Y, Wang LW, Lin CJ, Wang LY, Tsai WH, Ko MJ. Evaluation of feeding difficulties using videofluoroscopic swallow study and swallowing therapy in infants and children. Pediatr Neonatol 2023; 64:547-553. [PMID: 36849324 DOI: 10.1016/j.pedneo.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Infants and children with feeding difficulties have swallowing dysfunction and high risk of aspiration, which could be silent without choking, resulting in recurrent pneumonia and long-term respiratory morbidity. Videofluoroscopic swallow study (VFSS) is a useful tool for real-time visualization of the swallowing process and airway aspiration. This study reported a single-institutional 10-year experience of VFSS in pediatric patients with feeding difficulties and the efficacy of swallowing therapy. METHODS From 2011 to 2020, 30 infants and children with feeding difficulties received VFSS examinations in a medical center at a median age of 19 months (range 7 days-8 years). The images of the swallowing process (oral phase, triggering of pharyngeal swallowing, and pharyngeal phase) under videofluoroscopy were analyzed by a radiologist and a speech-language pathologist. Aspiration severity was assessed from VFSS observations and rated by an eight-point Penetration-Aspiration-Scale (PAS), with higher scores indicating increased severity. Swallowing therapy was performed by experienced speech-language therapists, and follow-up of oral feeding tolerance and risk of aspiration pneumonia was done. RESULTS Of the 30 patients, 24 (80%) had neurological deficits. High PAS scores (6-8) were observed in 25 (83.4%) patients, and 22 had a PAS score of 8, indicating silent aspiration. Of the 25 patients with high PAS scores, 19 (76%) had neurological deficits, and 18 (72%) depended on tube feeding at a median age of 20 months. Swallowing problems occurred most frequently during the pharyngeal phase in the patients with high PAS scores. VFSS-based swallowing therapy improved oral feeding ability and reduced aspiration episodes. CONCLUSION Infants and children with swallowing dysfunction and neurological deficits had high risk of severe aspiration. Swallowing problems in the pharyngeal phase were the most common VFSS findings in patients with severe aspiration. VFSS may help guide problem-oriented swallowing therapy to reduce the risk of recurrent aspiration.
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Affiliation(s)
- Yun Chou
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Lan-Wan Wang
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan; Department of Biotechnology and Food Technology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Jen Lin
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Lin-Yu Wang
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan; Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Wen-Hui Tsai
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan; Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Mei-Ju Ko
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan.
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15
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Duncan DR, Cohen A, Du M, Akkara A, Catacora A, Larson K, Williams N, Rosen RL. A Prospective Study of Parental Experience with Thickening Feeds for Children with Oropharyngeal Dysphagia and Gastroesophageal Reflux. J Pediatr 2023; 260:113510. [PMID: 37244581 PMCID: PMC10526688 DOI: 10.1016/j.jpeds.2023.113510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
Thickening is efficacious and commonly recommended for oropharyngeal dysphagia and gastroesophageal reflux. Little is known about parental experience with this practice. Results of this cross-sectional questionnaire study suggest attitudes are positive, but parents frequently adjust recipes/nipple sizes, which might increase aspiration risk. Clinical follow-up is essential to ensure safe feeding.
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Affiliation(s)
- Daniel R Duncan
- Division of Gastroenterology, Hepatology and Nutrition, Aerodigestive Center, Boston Children's Hospital, Boston, MA.
| | - Alexandra Cohen
- Division of Gastroenterology, Hepatology and Nutrition, Aerodigestive Center, Boston Children's Hospital, Boston, MA
| | - Maritha Du
- Division of Gastroenterology, Hepatology and Nutrition, Aerodigestive Center, Boston Children's Hospital, Boston, MA
| | - Anna Akkara
- Division of Gastroenterology, Hepatology and Nutrition, Aerodigestive Center, Boston Children's Hospital, Boston, MA
| | - Andrea Catacora
- Division of Gastroenterology, Hepatology and Nutrition, Aerodigestive Center, Boston Children's Hospital, Boston, MA
| | - Kara Larson
- Division of Gastroenterology, Hepatology and Nutrition, Aerodigestive Center, Boston Children's Hospital, Boston, MA
| | - Nina Williams
- Division of Gastroenterology, Hepatology and Nutrition, Aerodigestive Center, Boston Children's Hospital, Boston, MA
| | - Rachel L Rosen
- Division of Gastroenterology, Hepatology and Nutrition, Aerodigestive Center, Boston Children's Hospital, Boston, MA
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16
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Imdad A, Wang AG, Adlakha V, Crespo NM, Merrow J, Smith A, Tsistinas O, Tanner-Smith E, Rosen R. Laryngeal Penetration and Risk of Aspiration Pneumonia in Children with Dysphagia-A Systematic Review. J Clin Med 2023; 12:4087. [PMID: 37373780 DOI: 10.3390/jcm12124087] [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: 05/19/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
This study was a systematic review and meta-analysis that assessed the risk of aspiration pneumonia in children with laryngeal penetration or tracheal aspiration via a video-fluoroscopic study (VFSS) and compared the results to those for children with neither condition. Systematic searches were conducted using databases, including PubMed, Cochrane Library, and Web of Science. Meta-analysis was used to obtain summary odds ratios (OR) and 95% confidence intervals (CI). The overall quality of evidence was assessed using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. In total, 13 studies were conducted with 3159 participants. Combined results from six studies showed that laryngeal penetration on VFSS may be associated with aspiration pneumonia compared to no laryngeal penetration; however, the summary estimate was imprecise and included the possibility of no association (OR 1.44, 95% CI 0.94, 2.19, evidence certainty: low). Data from seven studies showed that tracheal aspiration might be associated with aspiration pneumonia compared to no tracheal aspiration (OR 2.72, 95% CI 1.86, 3.98, evidence certainty: moderate). The association between aspiration pneumonia and laryngeal penetration through VFSS seems to be weaker than that for tracheal aspiration. Prospective cohort studies with clear definitions of laryngeal penetration and that measure clinical and patient reported outcomes are needed to further define the association between laryngeal penetration and aspiration pneumonia.
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Affiliation(s)
- Aamer Imdad
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Alice G Wang
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Vaishali Adlakha
- Division of Pediatric Gastroenterology, Department of Pediatrics, McGovern Medical School, UTHealth Houston, Houston, TX 77030, USA
| | - Natalie M Crespo
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Jill Merrow
- Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Abigail Smith
- Health Science Library, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Olivia Tsistinas
- Health Science Library, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | | | - Rachel Rosen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Boston Children Hospital, Boston, MA 02115, USA
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Menahem S, Sehgal A, Wurzel DF. Persistent Tachypnoea in Early Infancy: A Clinical Perspective. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050789. [PMID: 37238337 DOI: 10.3390/children10050789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/27/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023]
Abstract
Tachypnoea in the newborn is common. It may arise from the many causes of the respiratory distress syndrome such as hyaline membrane disease, transient tachypnoea of the newborn, meconium aspiration etc. Congenital heart disease rarely presents with early tachypnoea on day one or two, in contrast to the early presentation of cyanosis, unless there is "pump" (ventricular) failure such as may occur in a cardiomyopathy/myocarditis, or as a result of severe obstruction to either ventricle. Space-occupying lesions within the chest, for example from a diaphragmatic hernia or a congenital cystic adenomatoid malformation, may present with early tachypnoea, as can a metabolic cause resulting in acidosis. The aim of this paper, however, is to focus on infants where the tachypnoea persists or develops beyond the newborn period, at times with minimal signs but occasionally with serious underlying pathology. They include causes that may have originated in the newborn but then persist; for example, arising from pulmonary hypoplasia or polycythemia. Many congenital cardiac abnormalities, particularly those causing left sided obstructive lesions, or those due to an increasing left to right shunt from large communications between the systemic and pulmonary circulations, need be considered. Respiratory causes, for example arising from aspiration, primary ciliary dyskinesia, cystic fibrosis, or interstitial lung disease, may lead to ongoing tachypnoea. Infective causes such as bronchiolitis or infantile wheeze generally are readily recognisable. Finally, there are a few infants who present with persistent tachypnoea over the first few weeks/months of their life who remain well and have normal investigations with the tachypnoea gradually resolving. How should one approach infants with persistent tachypnoea?
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Affiliation(s)
- Samuel Menahem
- Department of Paediatrics, Monash University, Clayton, VIC 3168, Australia
- Murdoch Children's Research Institute, University of Melbourne, Parkville, VIC 3052, Australia
- Australian Centre for Heart Health, University of Melbourne, Parkville, VIC 3052, Australia
- Melbourne Children's Cardiology/Adult Congenital Heart, 53 Kooyong Road Caulfield North, Melbourne, VIC 3161, Australia
| | - Arvind Sehgal
- Department of Paediatrics, Monash University, Clayton, VIC 3168, Australia
- Monash Newborn, Monash Health, Clayton, VIC 3168, Australia
- Neonatal Cardiovascular Research, Monash Health, Clayton, VIC 3168, Australia
| | - Danielle F Wurzel
- Murdoch Children's Research Institute, University of Melbourne, Parkville, VIC 3052, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Parkville, VIC 3052, Australia
- Allergy and Lung Health Unit, University of Melbourne, Parkville, VIC 3052, Australia
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Krug K, Hübl N, Freitag N, Schramm D. Safety, feasibility and diagnostic value of Clinical Swallow Examination and FEES in children between 0 and 24 months. Early Hum Dev 2023; 179:105732. [PMID: 36863223 DOI: 10.1016/j.earlhumdev.2023.105732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Clinical Swallowing Examination (CSE) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) are relevant diagnostic methods in pediatric dysphagia. Satisfactory and comprehensive healthcare is still not part of the standard diagnostic process. AIMS The purpose of this article is to evaluate the safety, feasibility, and diagnostic value of CSE and FEES in children 0-24 months of age. STUDY DESIGN A retrospective cross-sectional study which was conducted at the pediatric clinic of the University Hospital Düsseldorf, Germany, between 2013 and 2021. SUBJECTS A total of 79 infants and toddlers with suspected dysphagia were included. OUTCOME MEASURES Analyses of the cohort and FEES pathologies were performed. Dropout criterion, complications and change of diet were recorded. Chi-square identified associations between clinical symptoms and FEES results. RESULTS All FEES examinations were performed without complications and with a completion rate of 93.7 %. Anatomical abnormalities in the laryngeal region were diagnosed in 33 children. Wet voice was significantly associated with premature spillage (p = .028). CONCLUSIONS CSE and FEES are important and uncomplicated examinations for children with suspected dysphagia between 0 and 24 months. They are equally helpful for differential diagnosis of feeding disorders and anatomical abnormalities. The results underline the added value of combining both examinations and their importance for individual nutritional management. History taking and CSE are mandatory as they reflect the everyday eating situation. This study adds essential knowledge to the diagnostic work-up of dysphagic infants and toddlers. Standardizing the examinations and validating dysphagia scales are future tasks.
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Affiliation(s)
- Katrin Krug
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nicole Hübl
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nadine Freitag
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
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Chang AB, Oppenheimer JJ, Dunlap W, Lieberman JA, Irwin RS. Yardstick for managing cough. Part 2: in children. Ann Allergy Asthma Immunol 2023; 130:681-689. [PMID: 36736723 DOI: 10.1016/j.anai.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
Nationwide statistics in the United States and Australia reveal that cough of undifferentiated duration is the most common complaint for which patients of all ages seek medical care in the ambulatory setting. Management of chronic cough is one of the most common reasons for new patient visits to respiratory specialists. Because symptomatic cough is such a common problem and so much has been learned about how to diagnose and treat cough of all durations but especially chronic cough, this 2-part yardstick has been written to review in a practical way the evidence-based guidelines most of which have been developed from high-quality systematic reviews on how best to manage cough of all durations in adults, adolescents, and children. Chronic cough in children is often benign and self-limiting. Using established and validated protocols and specific pointers (clues in history, findings on examination) can aid the clinician in identifying causes when present and improve outcomes. In this manuscript, part 2 of the 2-part series, we provide evidence-based, expert opinion recommendations on the management of chronic cough in the pediatric patient (<14 years of age).
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland's University of Technology, and Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia; Menzies School of Health Research, Darwin, Australia.
| | | | - Whitney Dunlap
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts; Northeast Allergy, Asthma, and Immunology, Worcester, Massachusetts
| | - Jay Adam Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts
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20
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Miranda PP, Levy DS, Kieling RR. Aspiration in the First Year of Life and Later Tube Feeding: A Retrospective Cohort from a Low-Income Country. Dysphagia 2023; 38:192-199. [PMID: 35476230 DOI: 10.1007/s00455-022-10450-4] [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: 09/17/2021] [Accepted: 04/04/2022] [Indexed: 01/27/2023]
Abstract
The objective of this study is to investigate in infants submitted to videofluoroscopic swallowing study (VFSS) during the first year of life, the association between aspiration and later tube feeding, and to identify potential risk factors related to feeding route outcome. Retrospective cohort study with data from electronic health records was performed. Data were collected from infants < 12 months of age who underwent VFSS during inpatient hospital stay in the period between 2013 and 2018. Patient charts after 24 months of age were reviewed to ascertain the outcome and study factors, including VFSS findings, neonatal data, clinical comorbidities, nutritional status, ICU admissions, and hospital readmissions. Relative risk (RR) for tube feeding was calculated, and a Poisson regression with robust variance was used to identify potential risk factors. VFSS data from 164 patients < 1 year old were retrieved, of whom 112 (68%) contributed with data about feeding route after 2 years of age. Most infants were preterm < 37 weeks (66%), with a median age of 9.28 weeks at the time of the exam. Aspiration occurred in 33% of the patients, with no statistically significant difference between full-term or premature infants (p = 0.173). The relative risk of tube feeding after the age of 2 among infants who aspirated in VFSS was 0.74 (CI 0.25-2.16, p = 0.573). Poisson regression analysis showed that number of hospital readmissions (RR 1.04, 95%CI 1.01-1.07, p = 0.005) and gestational age < 34 weeks (RR 0.26, 95%CI 0.07-0.089, p = 0.032) were associated with later tube feeding. Early VFSS findings have low predictive value regarding later feeding route. Aspiration events should be considered as complementary information for clinical decision.
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Affiliation(s)
- Priscilla Poliseni Miranda
- Graduate Program in Child and Adolescent, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Deborah Salle Levy
- Speech and Language Pathology Service, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos Street, 2350 - Room 1045, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil
- Department of Health and Human Communication, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Renata Rocha Kieling
- Graduate Program in Child and Adolescent, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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21
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Jaffe N, Ball LJ, Evans S. Feeding and nutrition in the pediatric leukodystrophy patient. Curr Probl Pediatr Adolesc Health Care 2023; 53:101350. [PMID: 36609123 DOI: 10.1016/j.cppeds.2022.101350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Nicole Jaffe
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Laura J Ball
- Mississippi University for Women, Columbus, MS, USA
| | - Sally Evans
- Chief, Rehabilitation Medicine Children's Hospital of Philadelphia
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22
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Lawlor CM, Choi SS. Lipid‐Laden Macrophage Index as a Diagnostic Tool for Pediatric Aspiration: A Systematic Review. OTO Open 2023; 7:e33. [PMID: 36998564 PMCID: PMC10046735 DOI: 10.1002/oto2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/17/2022] [Indexed: 03/30/2023] Open
Abstract
Objective Lipid-laden macrophage index (LLMI) has been proposed as a marker for aspiration on bronchoalveolar lavage. It has also been studied as a marker for gastroesophageal reflux and other pulmonary diseases. This review aims to determine the clinical correlation between LLMI and pediatric aspiration. Data Sources PubMed (MeSH search), Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) portals through December 17th, 2020. Review Methods Preferred Reporting Items for Systematic Review and Meta-Analysis criteria were followed, and a quality assessment of included studies was performed using the Methodological Index for Non-Randomized Studies. Search criteria included all occurrences in the title or abstract of the terms "pulmonary aspiration" and "alveolar macrophages." Results Five studies describing 720 patients met inclusion, 3 retrospective case-control studies, and 2 prospective observational studies. Four studies suggested a link between elevated LLMI and aspiration, and 1 found no association. Control groups varied and included healthy nonaspirators to nonaspirators with other pulmonary diseases. Diagnosis of aspiration was not standardized across the studies. Three papers proposed cutoff values for LLMI, all different. Conclusion The existing literature indicates that LLMI is not a sensitive or specific marker for aspiration. Further study is needed to define the utility of LLMI in pediatric aspiration.
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Affiliation(s)
- Claire M. Lawlor
- Department of OtolaryngologyChildren's National Health SystemWashingtonDistrict of ColumbiaUSA
| | - Sukgi S. Choi
- Department of Otolaryngology and Communication EnhancementBoston Children's HospitalBostonMassachusettsUSA
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Frakking TT, Chang AB, Carty C, Newing J, Weir KA, Schwerin B, So S. Using an Automated Speech Recognition Approach to Differentiate Between Normal and Aspirating Swallowing Sounds Recorded from Digital Cervical Auscultation in Children. Dysphagia 2022; 37:1482-1492. [PMID: 35092488 PMCID: PMC9643257 DOI: 10.1007/s00455-022-10410-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022]
Abstract
Use of machine learning to accurately detect aspirating swallowing sounds in children is an evolving field. Previously reported classifiers for the detection of aspirating swallowing sounds in children have reported sensitivities between 79 and 89%. This study aimed to investigate the accuracy of using an automatic speaker recognition approach to differentiate between normal and aspirating swallowing sounds recorded from digital cervical auscultation in children. We analysed 106 normal swallows from 23 healthy children (median 13 months; 52.1% male) and 18 aspirating swallows from 18 children (median 10.5 months; 61.1% male) who underwent concurrent videofluoroscopic swallow studies with digital cervical auscultation. All swallowing sounds were on thin fluids. A support vector machine classifier with a polynomial kernel was trained on feature vectors that comprised the mean and standard deviation of spectral subband centroids extracted from each swallowing sound in the training set. The trained support vector machine was then used to classify swallowing sounds in the test set. We found high accuracy in the differentiation of aspirating and normal swallowing sounds with 98% overall accuracy. Sensitivity for the detection of aspiration and normal swallowing sounds were 89% and 100%, respectively. There were consistent differences in time, power spectral density and spectral subband centroid features between aspirating and normal swallowing sounds in children. This study provides preliminary research evidence that aspirating and normal swallowing sounds in children can be differentiated accurately using machine learning techniques.
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Affiliation(s)
- Thuy T Frakking
- Research Development Unit, Caboolture Hospital, Metro North Hospital & Health Service, McKean St, Caboolture, QLD, 4510, Australia.
- Centre for Clinical Research, School of Medicine, The University of Queensland, Herston, QLD, 4029, Australia.
- Speech Pathology Department, Gold Coast University Hospital, Gold Coast Hospital & Health Service, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, 501 Stanley St, South Brisbane, QLD, 4101, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Level 7, 62 Graham St, South Brisbane, QLD, 4101, Australia
| | - Christopher Carty
- Research Development Unit, Caboolture Hospital, Metro North Hospital & Health Service, McKean St, Caboolture, QLD, 4510, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, 4222, Australia
| | - Jade Newing
- School of Engineering and Built Environment, Griffith University, Parklands Dr, Southport, QLD, 4215, Australia
| | - Kelly A Weir
- Menzies Health Institute QLD & School of Health Sciences & Social Work, Griffith University, Gold Coast Campus, 1 Parklands Avenue, Southport, QLD, 4222, Australia
- Allied Health Research, Gold Coast University Hospital, Gold Coast Hospital & Health Service, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - Belinda Schwerin
- School of Engineering and Built Environment, Griffith University, Parklands Dr, Southport, QLD, 4215, Australia
| | - Stephen So
- School of Engineering and Built Environment, Griffith University, Parklands Dr, Southport, QLD, 4215, Australia
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24
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Duncan DR, Liu E, Growdon AS, Larson K, Rosen RL. A Prospective Study of Brief Resolved Unexplained Events: Risk Factors for Persistent Symptoms. Hosp Pediatr 2022; 12:1030-1043. [PMID: 36336644 PMCID: PMC9724174 DOI: 10.1542/hpeds.2022-006550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The risk of persistent symptoms after a brief resolved unexplained event (BRUE) is not known. Our objective was to determine the frequency and risk factors for persistent symptoms after BRUE hospitalizations. METHODS We conducted a prospective longitudinal cohort study of infants hospitalized with an admitting diagnosis of BRUE. Caregiver-reported symptoms, anxiety levels, and management changes were obtained by questionnaires during the 2-month follow-up period. Clinical data including repeat hospitalizations were obtained from a medical record review. Multivariable analyses with generalized estimating equations were conducted to determine the risk of persistent symptoms. RESULTS Of 124 subjects enrolled at 51.6 ± 5.9 days of age, 86% reported symptoms on at least 1 questionnaire after discharge; 65% of patients had choking episodes, 12% had BRUE spells, and 15% required a repeat hospital visit. High anxiety levels were reported by 31% of caregivers. Management changes were common during the follow-up period and included 30% receiving acid suppression and 27% receiving thickened feedings. Only 19% of patients had a videofluoroscopic swallow study while admitted, yet 67% of these studies revealed aspiration/penetration. CONCLUSIONS Many infants admitted with BRUE have persistent symptoms and continue to access medical care, suggesting current management strategies insufficiently address persistent symptoms. Future randomized trials will be needed to evaluate the potential efficacy of therapies commonly recommended after BRUE.
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Affiliation(s)
- Daniel R. Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research
| | - Amanda S. Growdon
- Hospital Medicine Program, Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition
| | - Rachel L. Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition
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25
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Stafler P, Akel K, Eshel Y, Shimoni A, Grozovski S, Mei‐Zahav M, Levine H, Gendler Y, Blau H, Prais D. Videofluoroscopy compared with clinical feeding evaluation in children with suspected aspiration. Acta Paediatr 2022; 111:1441-1449. [PMID: 35316543 PMCID: PMC9325498 DOI: 10.1111/apa.16338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Aim Videofluoroscopy swallow studies (VFSS) are gold standard to diagnose aspiration in children but require resources and radiation compared with clinical feeding evaluation (CFE). We evaluated their added value for diagnosis, feeding management and clinical status. Methods A retrospective single‐centre cross‐sectional study of children aged 0–18 years, with respiratory morbidity, referred for VFSS at a tertiary pediatric hospital. Results A total of 113 children, median age (range) 2.2 years (0.1–17.9), underwent VFSS. Diagnosis included chronic pulmonary aspiration (CPA), 87 (77%); neurological, 73 (64%); gastrointestinal, 73 (64%) and congenital heart disease, 42 (37%), not mutually exclusive. Forty‐six (41%) aspirated, 9 (8%) only overtly and 37 (33%) including silent aspirations. Those with CPA or cerebral palsy were more likely to have VFSS aspiration, OR 3.2 and 9.8 respectively. Feeding recommendations after VFSS differed significantly from those based on prior CFE, p < 0.001: The rate of exclusively orally fed children rose from 65% to 79%, p = 0.006; exclusively enterally fed children from 10% to 14%; p = 0.005. During the year after VFSS, there were significantly less antibiotic courses, total and respiratory admissions. Conclusion In this population with high prevalence of clinically suspected CPA, VFSS altered feeding management compared with CFE and may have contributed to subsequent clinical improvement.
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Affiliation(s)
- Patrick Stafler
- Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Khaled Akel
- Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel
| | - Yuliana Eshel
- Occupational Therapy Department Schneider Children's Medical Center of Israel Petach Tikva Israel
| | - Adi Shimoni
- Occupational Therapy Department Schneider Children's Medical Center of Israel Petach Tikva Israel
| | - Sylvia Grozovski
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Radiology Institute Schneider Children's Medical Center of Israel Petach Tikva Israel
| | - Meir Mei‐Zahav
- Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Hagit Levine
- Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yulia Gendler
- The Department of Nursing School of Health Sciences Ariel University Ariel Israel
| | - Hannah Blau
- Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Dario Prais
- Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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26
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Lin TH, Yang CW, Chang WK. Evaluation of Oropharyngeal Dysphagia in Older Patients for Risk Stratification of Pneumonia. Front Immunol 2022; 12:800029. [PMID: 35185865 PMCID: PMC8847226 DOI: 10.3389/fimmu.2021.800029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) are widely used techniques to feed older patients with oropharyngeal dysphagia. Aspiration pneumonia is the most common cause of death in these patients. This study aimed to evaluate the role of oropharyngeal dysphagia in older patients on long-term enteral feeding for risk stratification of pneumonia requiring hospitalization. Methods We performed modified flexible endoscopic evaluation of swallowing to evaluate oropharyngeal dysphagia in older patients and conducted prospective follow-up for pneumonia requiring hospitalization. A total of 664 oral-feeding patients and 155 tube-feeding patients were enrolled. Multivariate Cox analysis was performed to identify risk factors of pneumonia requiring hospitalization. Results Multivariate analyses showed that the risk of pneumonia requiring hospitalization significantly increased in older patients and in patients with neurological disorders, tube feeding, and oropharyngeal dysphagia. Subgroup analysis revealed that the risk of pneumonia requiring hospitalization was significantly lower in patients with PEG than in those with NGT among the patients with oropharyngeal dysphagia (adjusted hazard ratio 0.26, 95% confidence interval: 0.11–0.63, P = 0.003). Conclusions For older patients with oropharyngeal dysphagia requiring long-term enteral tube feeding, PEG is a better choice than NGT. Further research is needed to elucidate the role of oropharyngeal dysphagia in enteral feeding in older patients.
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Affiliation(s)
- Tai-Han Lin
- Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Yang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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27
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Schepers FV, van Hulst K, Spek B, Erasmus CE, van den Engel‐Hoek L. Dysphagia limit in children with cerebral palsy aged 4 to 12 years. Dev Med Child Neurol 2022; 64:253-258. [PMID: 34418067 PMCID: PMC9291064 DOI: 10.1111/dmcn.15031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 12/02/2022]
Abstract
AIM To assess the dysphagia limit in children with cerebral palsy (CP) according to Eating and Drinking Ability Classification System (EDACS) level, sex, and age compared to typically developing children. METHOD Seventy-seven children with CP (54 males, 23 females; mean age 7y 6mo, SD 2y 2mo, age range 4-12y) were assessed with the Maximum Volume Water Swallow Test. Median dysphagia limit in the CP group was compared with data of typically developing children. RESULTS The dysphagia limit of children with CP differed significantly (p<0.001) from typically developing children. The latter showed a threefold higher median dysphagia limit (22mL) compared to children with CP in EDACS level I (7mL). The higher the EDACS level, the lower the dysphagia limit in children with CP. EDACS level explained 55% of the variance in the dysphagia limit of the CP group. INTERPRETATION Where children with CP in EDACS levels IV and V showed that their capacity met the level of their performance, children in EDACS level I had the ability to perform a maximum capacity task, but still had a threefold lower median dysphagia limit than typically developing children. Establishment of the dysphagia limit should be part of general swallowing assessment in children with CP.
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Affiliation(s)
- Florentine V Schepers
- Department of Rehabilitation MedicineUniversity Medical Centre GroningenUniversity of GroningenGroningenthe Netherlands
| | - Karen van Hulst
- Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreAmalia Children’s HospitalNijmegenthe Netherlands
| | - Bea Spek
- Department of Epidemiology and DatascienceAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamthe Netherlands
| | - Corrie E Erasmus
- Department of Paediatric NeurologyDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreAmalia Children’s HospitalNijmegenthe Netherlands
| | - Lenie van den Engel‐Hoek
- Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreAmalia Children’s HospitalNijmegenthe Netherlands
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28
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Fiori S, Moretti E, Amador C, Martinelli A, Scaramuzzo RT, Controzzi T, Battini R, Filippi L, Guzzetta A, Gargani L. Lung ultrasound in young children with neurological impairment: A proposed integrative clinical tool for deaeration-detection related to feeding. Front Pediatr 2022; 10:932409. [PMID: 35967558 PMCID: PMC9363586 DOI: 10.3389/fped.2022.932409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Infants and children with neurological impairment, such as cerebral palsy (CP), often experience abnormal ingestion functions, including oropharyngeal dysphagia and gastroesophageal reflux disease, which led to aspiration-related respiratory complications, morbidity, hospitalization, or death. There is a lack of evidence-based, repeatable, infant-friendly instrumental procedures to assess aspiration-risk in infants with CP or other neurological disorders, with also a lack of clinical assessment measures to support the use of more invasive diagnostic techniques. To this purpose, in the current study we explore the feasibility of lung ultrasound (LUS), to assess lung deaeration possibly related to aspiration during meal, in a cohort of 35 subjects affected by CP or other encephalopathies, and 10 controls in the same age-range. We coupled LUS procedure with meal caregiver administration for each child. Our results support the feasibility of this innovative approach in the clinical setting. Exploratory findings revealed a number of lung abnormalities likely related to abnormal ingestion function in subjects. Subgroup analyses revealed possible differences in LUS abnormalities between CP and other encephalopathies, possibly related to different mechanism of disease or dysfunction. Also, some evidences arose about the possible relationship between such LUS abnormalities and feeding and swallowing abilities in CP or other encephalopathies. LUS showed preliminarily feasibility and effectiveness in detecting meal-related LUS abnormalities in a dynamic manner in the clinical setting. This approach demonstrated usefulness as a potential tool for improving assessment and management in complex care of infants and young children with severe neurological disorders.
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Affiliation(s)
- Simona Fiori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | | | | | | | | | - Tiziana Controzzi
- Department of Neonatal Intensive Care Unit, Santa Chiara Hospital, Pisa, Italy
| | - Roberta Battini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | - Luca Filippi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Neonatal Intensive Care Unit, Santa Chiara Hospital, Pisa, Italy
| | - Andrea Guzzetta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology National Research Council of Italy (CNR), Pisa, Italy.,Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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29
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Jančíková J, Bezděková D, Urbanová P, Dohnalová L, Jabandžiev P, Tedla M, Frajková Ž, Jarkovský J, Urík M. Association between Swallowing-Related Questionnaire Responses and Pathological Signs on Videofluoroscopy in Children. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121109. [PMID: 34943305 PMCID: PMC8700346 DOI: 10.3390/children8121109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 12/30/2022]
Abstract
The aim of this study was to identify relationships in children between responses to specific questions of interest in a clinical questionnaire concerning swallowing-related difficulties and pathological signs on a videofluoroscopic swallowing study (VFSS). A prospective data analysis was made of children evaluated with swallowing disorder between January 2018 and April 2021 at a tertiary care centre. Each child enrolled in the study underwent a subjective evaluation (targeted questions) and instrumental examination (VFSS). In total, 51 children suffering from swallowing problems (32 with a neurological disorder and 19 without neurological disorder) were included into the study. Our results showed there was a correlation between the occurrence of specific symptoms (wet voice, wet breathing, recurrent respiratory infections, chronic mucus) and other pathological signs on a VFSS (laryngeal penetration, residua, nasal regurgitation). The evaluation of these specific questions is a reliable and useful method for the management of dysphagia in neonates and infants. It can help us in selecting those patients for which it is appropriate to perform a VFSS.
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Affiliation(s)
- Jana Jančíková
- Department of Pediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, 61300 Brno, Czech Republic; (J.J.); (D.B.)
| | - Denisa Bezděková
- Department of Pediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, 61300 Brno, Czech Republic; (J.J.); (D.B.)
| | - Petra Urbanová
- Department of Pediatric Radiology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, 61300 Brno, Czech Republic; (P.U.); (L.D.)
| | - Lucie Dohnalová
- Department of Pediatric Radiology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, 61300 Brno, Czech Republic; (P.U.); (L.D.)
| | - Petr Jabandžiev
- Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, 61300 Brno, Czech Republic;
| | - Miroslav Tedla
- Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, 85107 Bratislava, Slovakia; (M.T.); (Ž.F.)
| | - Žofia Frajková
- Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, 85107 Bratislava, Slovakia; (M.T.); (Ž.F.)
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University Brno, 62500 Brno, Czech Republic;
| | - Milan Urík
- Department of Pediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, 61300 Brno, Czech Republic; (J.J.); (D.B.)
- Correspondence: ; Tel.: +421-532-234-440
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30
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Reddihough DS, Chang AB. The challenges of posterior drooling in children with cerebral palsy. Dev Med Child Neurol 2021; 63:1013. [PMID: 33864259 DOI: 10.1111/dmcn.14898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Dinah S Reddihough
- Neurodevelopment and Disability, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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31
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DellaBadia K, Tauber D. Respiratory concerns in children with medical complexity. Curr Probl Pediatr Adolesc Health Care 2021; 51:101072. [PMID: 34657813 DOI: 10.1016/j.cppeds.2021.101072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Children with medical complexity (CMC) are a diverse group of children affected by a spectrum of chronic disorders and physiologic abnormalities. Due to their underlying disorders, they disproportionately experience respiratory comorbidities and complications. Respiratory-related complications that arise in this population often begin subtly and progress over time and can result in lung injury, respiratory insufficiency, and eventual chronic respiratory failure. CMC make up a substantial proportion of pediatric hospitalizations and healthcare expenditures, with respiratory-related illness being one of the leading causes of admission. It is, therefore, important for the practitioner caring for these children to have knowledge of the common respiratory concerns in this population as well as prevention and management strategies. This review will describe the most common respiratory concerns in CMC and will provide an overview of diagnosis and management.
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Affiliation(s)
- Kristine DellaBadia
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
| | - Danna Tauber
- Division of Pulmonary and Sleep Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States.
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32
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Allen J, Zareen Z, Doyle S, Whitla L, Afzal Z, Stack M, Franklin O, Green A, James A, Leahy TR, Quinn S, Elnazir B, Russell J, Paran S, Kiely P, Roche EF, McDonnell C, Baker L, Hensey O, Gibson L, Kelly S, McDonald D, Molloy EJ. Multi-Organ Dysfunction in Cerebral Palsy. Front Pediatr 2021; 9:668544. [PMID: 34434904 PMCID: PMC8382237 DOI: 10.3389/fped.2021.668544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.
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Affiliation(s)
- John Allen
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | | | - Samantha Doyle
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham, United Kingdom
| | - Laura Whitla
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zainab Afzal
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Maria Stack
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Orla Franklin
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Andrew Green
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Adam James
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Timothy Ronan Leahy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Shoana Quinn
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Basil Elnazir
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - John Russell
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sri Paran
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Patrick Kiely
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Edna Frances Roche
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Ciara McDonnell
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Louise Baker
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | | | - Louise Gibson
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Stephanie Kelly
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Denise McDonald
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Eleanor J. Molloy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Department of Neonatology, The Coombe Women and Infants University Hospital, Dublin, Ireland
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33
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Lagarde MLJ, van Doorn JLM, Weijers G, Erasmus CE, van Alfen N, van den Engel-Hoek L. Tongue movements and teat compression during bottle feeding: A pilot study of a quantitative ultrasound approach. Early Hum Dev 2021; 159:105399. [PMID: 34126586 DOI: 10.1016/j.earlhumdev.2021.105399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
Nutritive sucking is a complex process, essential to proper growth and development. The complexity of this oral sensorimotor activity includes movements of the tongue and jaw. Tongue movements during nutritive sucking can only be visualized with instrumented methods such as ultrasound. Until now, studies using ultrasound during nutritive sucking performed measurements on each individual ultrasound image frame, which was quite time-consuming. The aim of this pilot study was to automatically process ultrasound video recordings in healthy infants during bottle feeding to measure teat compression and tongue movements. Tongue movements and teat compression during bottle feeding were visualized and recorded using 2D dynamic ultrasound imaging. A custom-made semi-automated analysis-routine was developed. Teat compression was expressed as the median difference in teat diameter during the recording. Tongue movements were expressed as the displacement of the tongue along four evenly distributed image lines and the corresponding time-shifts between those lines. The recordings of 12 out of 14 participants were adequate for the analysis of tongue movements. Teat compression could be analysed in the recordings of 6 participants. The reliability of our analysis-routine was considered to be good, and the analysis-routine was more time-efficient than manual frame-by-frame analysis. This quantitative analysis-routine is a promising tool, that can be used efficiently and accurately in the future to collect normative data that can serve as reference values to distinguish normal from abnormal tongue movements in infants with feeding difficulties.
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Affiliation(s)
- M L J Lagarde
- Radboud university medical center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands.
| | - J L M van Doorn
- Radboud university medical center, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - G Weijers
- Radboud university medical center, Medical Ultrasound Imaging Center (MUSIC), Department of Radiology and Nuclear Medicine, Nijmegen, the Netherlands
| | - C E Erasmus
- Radboud university medical center, Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - N van Alfen
- Radboud university medical center, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - L van den Engel-Hoek
- Radboud university medical center, Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
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Ibañez VF, Peters KP, Vollmer TR. A Comparison of re-presentation and modified chin prompt to treat different topographies of liquid expulsion. J Appl Behav Anal 2021; 54:1586-1607. [PMID: 34329488 DOI: 10.1002/jaba.872] [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: 09/11/2020] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/07/2022]
Abstract
Treatment of one behavior in the chain of consumption might be associated with the emergence of other problematic behaviors. For example, some children with feeding disorders expel liquid. Moreover, the form in which children expel liquid might vary and influence whether a treatment to reduce liquid expulsion will result in clinically meaningful outcomes. In the current investigation, we first identified topographies of liquid expulsion (e.g., forceful, run out) for each child. We then compared and evaluated the effects of 2 procedures, a modified chin prompt and re-presentation, on the liquid expulsion of 3 children with feeding disorders. For 2 participants, expulsion decreased to clinically meaningful levels with a modified chin prompt or re-presentation. However, for 1 participant, expulsion decreased to clinically meaningful levels only when we combined the modified chin prompt and re-presentation as part of a treatment package. We discuss possible mechanisms underlying the effects of a modified chin prompt and re-presentation, in addition to areas for future research.
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35
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Curtis JS, Kennedy SE, Attarha B, Edwards L, Jacob R. Upper Gastrointestinal Disorders in Adult Patients with Intellectual and Developmental Disabilities. Cureus 2021; 13:e15384. [PMID: 34094790 PMCID: PMC8170855 DOI: 10.7759/cureus.15384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The purpose of this literature review is to address the diagnosis and treatment of upper gastrointestinal (GI) disorders in patients with intellectual and developmental disabilities (IDD). Manifestations of upper GI dysmotility and disorders include dysphagia, pulmonary aspiration, malnutrition, gastroesophageal reflux, and gastritis, all of which can impact a person’s quality of life and lead to chronic, life-threatening conditions. This article will explore the existing diagnostic methods and treatments for gastrointestinal disorders as they relate to patients with IDD.
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Affiliation(s)
- Jack S Curtis
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Sara E Kennedy
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Barrett Attarha
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Linda Edwards
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Rafik Jacob
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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Aguirregomezcorta FR, Osona B, Peña-Zarza JA, Gil JA, Vetter-Laracy S, Frontera G, Figuerola J, Bover-Bauza C. Diagnosis and management of aspiration using fiberoptic endoscopic evaluation of swallowing in a Pediatric Pulmonology Unit. Pediatr Pulmonol 2021; 56:1651-1658. [PMID: 33620151 DOI: 10.1002/ppul.25328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Swallowing disorders lead to chronic lung aspiration. Early detection and treatment of aspiration in children with dysphagia are important to prevent lung damage. Diagnosis of aspiration, which may be silent, requires an instrumental study such as fiberoptic endoscopic evaluation of swallowing (FEES). Despite its usefulness, it is rarely practiced by pediatric pulmonologists. This study aimed to evaluate the feasibility and utility of FEES performed in the pediatric respiratory unit of a tertiary hospital, analyze the clinical characteristics, endoscopic findings and proposed treatments, and identify the factors associated with penetration or aspiration. METHODS Medical records of 373 children with suspected aspiration who were referred to the pediatric respiratory unit for FEES were reviewed retrospectively. Clinical characteristics, FEES findings, and the proposed treatments were analyzed. RESULTS Laryngeal penetration/aspiration was seen in 47.9% of the patients. The most common associated conditions were neurological disease and prematurity. The most frequently observed endoscopic finding was altered laryngeal sensitivity (36.5%). Intervention was recommended in 54.2% of the patients. Complications were not seen during any of the procedures. The multivariate logistic regression model revealed an independent association between aspiration and alterations in laryngeal sensitivity (odds ratio [OR], 5.68), pharyngeal pooling (OR, 11.47), and post-swallowing food residues (OR, 8.08). CONCLUSIONS The FEES procedure performed by pediatric pulmonologists is a reliable method for diagnosing aspiration in children. It can be safely executed by trained pulmonologists, and significant endoscopic signs other than aspiration can guide in the diagnosis and management recommendations.
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Affiliation(s)
- Fernando R Aguirregomezcorta
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Borja Osona
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Jose A Peña-Zarza
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Research Group in Sleep Apnea and Hypopnea Syndrome, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Jose A Gil
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Susanne Vetter-Laracy
- Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain.,Division of Neonatology, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Guiem Frontera
- Balearic Islands Health Research Institute (IdISBa), 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.,Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Catalina Bover-Bauza
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
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Duncan DR, DiFilippo C, Kane M, Lurie M, McSweeney ME, Rosen RL. Overlapping Symptoms of Gastroesophageal Reflux and Aspiration Highlight the Limitations of Validated Questionnaires. J Pediatr Gastroenterol Nutr 2021; 72:372-377. [PMID: 33264182 PMCID: PMC9765758 DOI: 10.1097/mpg.0000000000002987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Infants frequently present with feeding difficulties and respiratory symptoms, which are often attributed to gastroesophageal reflux but may be because of oropharyngeal dysphagia with aspiration. The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) is a clinical measure of gastroesophageal reflux disease but now there is greater understanding of dysphagia as a reflux mimic. We aimed to determine the degree of overlap between I-GERQ-R and evidence of dysphagia, measured by Pediatric Eating Assessment Tool-10 (Pedi-EAT-10) and videofluoroscopic swallow study (VFSS). METHODS We performed a prospective study of subjects <18 months old with feeding difficulties. All parents completed Pedi-EAT-10 and I-GERQ-R as a quality initiative to address parental feeding concerns. I-GERQ-R results were compared with Pedi-EAT-10 and, whenever available, results of prior VFSS. Pearson correlation coefficients were calculated to determine the relationship between scores. Groups were compared with 1-way ANOVA and Fisher exact test. ROC analysis was completed to compare scores with VFSS results. RESULTS One hundred eight subjects with mean age 7.1 ± 0.5 months were included. Pedi-EAT-10 and I-GERQ-R were correlated (r = 0.218, P = 0.023) in all subjects and highly correlated in the 77 subjects who had prior VFSS (r = 0.369, P = 0.001). The blue spell questions on I-GERQ-R had relative risk 1.148 (95% confidence interval [CI] 1.043-1.264, P = 0.142) for predicting aspiration/penetration on VFSS, with 100% specificity. Scores on the question regarding crying during/after feedings were also higher in subjects with abnormal VFSS (1.1 ± 0.15 vs 0.53 ± 0.22, P = 0.04). CONCLUSIONS I-GERQ-R and the Pedi-EAT-10 are highly correlated. I-GERQ-R results may actually reflect oropharyngeal dysphagia and not just gastroesophageal reflux disease in infants.
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Affiliation(s)
- Daniel R. Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Courtney DiFilippo
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Madeline Kane
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Margot Lurie
- 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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Zambaiti E, Virgone C, Bisoffi S, Stefanizzi R, Fascetti Leon F, Gamba P. Long-Term Analysis of Respiratory-Related Complications Following Gastrostomy Placement with or without Fundoplication in Neurologically Impaired Children: A Retrospective Cohort Study. CHILDREN-BASEL 2021; 8:children8010022. [PMID: 33406700 PMCID: PMC7823901 DOI: 10.3390/children8010022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/31/2020] [Accepted: 01/01/2021] [Indexed: 12/19/2022]
Abstract
Gastrostomy placement is crucial in neurologically impaired (NI) children to ensure an adequate food intake and a safe route for drugs administration and to reduce the risk of primary aspiration. NI patents are more prone to gastroesophageal reflux. The association with fundoplication is deemed to reduce reflux-related respiratory complications. However, long-term benefits of this approach are not clear. We therefore aimed to compare long-term reflux-related respiratory complications of gastrostomy only (GO) to gastrostomy with fundoplication (GF). We retrospectively reviewed 145 consecutive NI children managed from 2008 to 2018. As long-term outcomes, we analyzed number and length of hospital admissions (Reflux-Related-Hospitalization, RRH) and emergency department accesses (Reflux-Related-Accesses, RRA) due to respiratory problems. Results were analyzed with appropriate statistical method. Median age at referral and at gastrostomy placement were 2.2 and 3.4 years (SD 5.6), respectively. Median follow-up was four years (range 1-12). Anti-reflux procedures were performed in 26/145 patients (18%); tracheotomy in 23/145 (16%). RRH following surgery showed lower number of admissions/year (0.32 vs. 1 for GO vs. GF, p < 0.005) and days hospitalization/year (3 vs. 13, p = 0.08) in GO compared to GF; RRA was similar (0.60 vs. 0.65, p = 0.43). Gastrostomy placement alone appeared not to be inferior to gastrostomy plus fundoplication with respect to long-term respiratory-related outcomes for NI children in our center.
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Affiliation(s)
- Elisa Zambaiti
- Division of Pediatric Surgery, Department Women’s and Children’s Health, University Hospital of Padua, 35121 Padua, Italy; (E.Z.); (S.B.); (F.F.L.); (P.G.)
| | - Calogero Virgone
- Division of Pediatric Surgery, Department Women’s and Children’s Health, University Hospital of Padua, 35121 Padua, Italy; (E.Z.); (S.B.); (F.F.L.); (P.G.)
- Correspondence:
| | - Silvia Bisoffi
- Division of Pediatric Surgery, Department Women’s and Children’s Health, University Hospital of Padua, 35121 Padua, Italy; (E.Z.); (S.B.); (F.F.L.); (P.G.)
| | - Roberta Stefanizzi
- Division of Pediatrics, Department Women’s and Children’s Health, University Hospital of Padua, 35121 Padua, Italy;
| | - Francesco Fascetti Leon
- Division of Pediatric Surgery, Department Women’s and Children’s Health, University Hospital of Padua, 35121 Padua, Italy; (E.Z.); (S.B.); (F.F.L.); (P.G.)
| | - Piergiorgio Gamba
- Division of Pediatric Surgery, Department Women’s and Children’s Health, University Hospital of Padua, 35121 Padua, Italy; (E.Z.); (S.B.); (F.F.L.); (P.G.)
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Pseudomonas aeruginosa infection in respiratory samples in children with neurodisability-to treat or not to treat? Eur J Pediatr 2021; 180:2897-2905. [PMID: 33822245 PMCID: PMC8346391 DOI: 10.1007/s00431-021-04025-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022]
Abstract
The objective was to investigate the prevalence of Pseudomonas aeruginosa (PA) in patients with complex neurodisability and current treatment practice in our centre in order to inform future guidelines. A retrospective case note review was undertaken at a tertiary children's hospital. One hundred sixty-two patients (mean age 11.7 years) with a primary diagnosis of neuromuscular disease (NMD) or severe cerebral palsy (CP) and a respiratory sample sent for analysis during the study period were studied. Associations between PA in respiratory samples and diagnosis, long-term ventilation, presence of a gastrostomy or a tracheostomy, antibiotic choice, clinical deterioration and adverse events were analysed. Twenty-five (15%) had one or more PA isolate in respiratory samples. There was a significant association between PA in respiratory samples and tracheostomy (p<0.05). In 52% samples, multiple pathogens co-existed. There was no significant association between choice of antibiotic and clinical outcome but when antibiotics were changed to specific PA antibiotics during the course of the illness, all resulted in clinical improvement. Twenty-six episodes involving 8 patients with recurrent admissions involved PA organisms that were resistant to one or more antibiotics.Conclusions: A larger prospective study may establish clearer criteria for guideline development. Techniques such as point-of-care testing to identify virulent strains of PA may improve patient outcomes and prevent the development of antibiotic resistance in the future. What is Known: •Children with complex neurodisability are at increased risk of respiratory morbidity and of infection with gram-negative organisms such as Pseudomonas aeruginosa. •There are currently no guidelines to inform treatment choices in this group of vulnerable children. What is New: •15% children in this study population had Pseudomonas aeruginosa in respiratory samples during a 12-month period, the majority of whom did not require critical care treatment. Thirteen of these children had a tracheostomy in situ and 12 did not. •In those that deteriorated clinically or developed antibiotic resistant organisms, earlier detection and targeted treatment of Pseudomonas aeruginosa may have prevented deterioration.
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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]
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Hamed EA, Mohammad SA, Rawash Eldieb LM, Shalaby MH. Upper gastrointestinal series in children: what surgeons need to know. ANNALS OF PEDIATRIC SURGERY 2020. [DOI: 10.1186/s43159-020-00061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Upper gastrointestinal (UGI) series is the standard imaging tool for diagnosis of structural and functional abnormalities affecting the esophagus, stomach, and proximal small bowel. The aim of this study was to delineate the clinical indications for UGI series in children that are associated with the presence of significant radiological abnormalities aiming for more standardized care for those patients.
Results
UGI series of 118 patients was analyzed with calculation of clinical score. Vomiting was the most frequent primary complaint (63.6%), followed by dysphagia and recurrent chest infection. Forty-nine patients had positive upper GI findings (42%). The most detected abnormality was related to the stomach and duodenum (21.4%). Variable degrees of idiopathic gastroesophageal reflux were detected in 16 patients (13.6%). Patients with clinical score 2 or more had significantly more prevalence of abnormal findings (p = .001). Vomiting (especially when bilious), underweight, aspiration, and recurrent chest infection were strong predictors of abnormal findings on upper GI series (p = 0.007, 0.001, 0.009, and 0.001, respectively) and increased the diagnostic yield of upper GI series for detection of abnormalities by 3.48, 9.6, 4, and 4.12 times, respectively.
Conclusion
Diagnostic yield of UGI series was relatively higher in patients having two or more symptoms (clinical score 2 or more) and in children with bilious vomiting, aspiration and underweight, or repeated chest infection.
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The Ethics of Feeding the Aspirating Child in an Age of Increasing Patient Complexity. J Pediatr Gastroenterol Nutr 2020; 71:586-588. [PMID: 33093363 DOI: 10.1097/mpg.0000000000002919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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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.
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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.
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Mills N, Keesing M, Geddes D, Mirjalili SA. Flexible Endoscopic Evaluation of Swallowing in Breastfeeding Infants With Laryngomalacia: Observed Clinical and Endoscopic Changes With Alteration of Infant Positioning at the Breast. Ann Otol Rhinol Laryngol 2020; 130:653-665. [PMID: 33090012 DOI: 10.1177/0003489420965636] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This retrospective cohort study uses endoscopic assessment of the pharyngeal phase of swallowing in infants with laryngomalacia, to ascertain the impact of infant positioning on airway compromise and fluid dynamics during breastfeeding. The study aims to identify whether modification of infant positioning at the breast may improve the possibility of safe, successful breastfeeding in infants with laryngomalacia and concurrent breastfeeding difficulty. METHODS Twenty-three infants referred for noisy breathing and difficulty feeding were assessed with flexible endoscopic evaluation of swallowing (FEES) during breastfeeding. All had endoscopically confirmed laryngomalacia. During FEES, observations were made of clinical signs of airway compromise as well as endoscopically observable anatomical features and swallowing dynamics during breastfeeding, including tongue base position, view of laryngeal inlet and vocal folds, dynamic supraglottic soft tissue collapse, timing of milk flow into pyriform fossae/hypopharynx relative to sucking, and presence of penetration and/or aspiration. If airway and/or swallowing compromise was present, the infant's initial position at the breast was altered from supine or semi lateral decubitus position to semi-prone, with a description of the clinical and endoscopically observable changes that subsequently occurred. RESULTS Signs of dynamic airway obstruction and/or compromised airway protection with swallowing were present in 20 of the 23 infants (87%) in their initial supine or semi lateral decubitus position. These 20 infants were repositioned to semi-prone, with improvement and/or resolution of stridor and an improved ability to maintain latch in all infants. Continued endoscopic evaluation following positional change was possible in 16 infants, identifying anterior positioning of the tongue base, reduced dynamic supraglottic tissue collapse, reduced volume of milk flow into pyriform fossae during pauses in sucking and resolution of penetration and aspiration. CONCLUSION This study has shown how alteration of breastfeeding position to semi-prone may improve dynamic airway obstruction and reduce aspiration risk in infants with laryngomalacia.
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Affiliation(s)
- Nikki Mills
- Paediatric Otolaryngology Department, Starship Children's Hospital, Auckland, New Zealand.,Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Melissa Keesing
- Paediatric Speech-Language Therapy Department, Starship Children's Hospital, Auckland, New Zealand
| | - Donna Geddes
- School of Molecular Sciences, Faculty of Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Seyed Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Henningfeld J, Lang C, Erato G, Silverman AH, Goday PS. Feeding Disorders in Children With Tracheostomy Tubes. Nutr Clin Pract 2020; 36:689-695. [PMID: 32700397 DOI: 10.1002/ncp.10551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/31/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jennifer Henningfeld
- Medical College of Wisconsin Division of Pediatric Pulmonology and Sleep Medicine Milwaukee Wisconsin USA
| | - Cecilia Lang
- Children's Hospital of Wisconsin Department of Respiratory Care Services Milwaukee Wisconsin USA
| | - Gina Erato
- Medical College of Wisconsin Division of Pediatric Gastroenterology and Nutrition Milwaukee Wisconsin USA
| | - Alan H. Silverman
- Medical College of Wisconsin Division of Pediatric Gastroenterology and Nutrition Milwaukee Wisconsin USA
| | - Praveen S. Goday
- Medical College of Wisconsin Division of Pediatric Gastroenterology and Nutrition Milwaukee Wisconsin USA
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Garand KLF, McCullough G, Crary M, Arvedson JC, Dodrill P. Assessment Across the Life Span: The Clinical Swallow Evaluation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:919-933. [PMID: 32650662 DOI: 10.1044/2020_ajslp-19-00063] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This clinical focus article considers the roles of the clinical swallow examination (CSE) as a clinically meaningful assessment method used in both adult and pediatric populations. Method This clinical focus article explores the utility of the CSE across the life span. Specifically, components, reliability, standardized assessments, and limitations of the CSE within the adult and pediatric populations are highlighted. Conclusions The CSE remains a crucial assessment tool for the speech-language pathologist. The experienced clinician can make important judgments regarding patient safety and function. If the CSE is conducted mindfully and methodically, findings can help chart the course of care for individuals needing additional assessment and possibly intervention.
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Affiliation(s)
| | - Gary McCullough
- Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC
| | - Michael Crary
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - Joan C Arvedson
- Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin-Milwaukee
| | - Pamela Dodrill
- Department of Otolaryngology, Boston Children's Hospital Boston, MA
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Ha JF. Unilateral vocal fold palsy & dysphagia: A review. Auris Nasus Larynx 2020; 47:315-334. [DOI: 10.1016/j.anl.2020.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
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Radford C, Marshall J, Herbert A, Irving H, Weir K. Risk Feeding: An Australian Pediatric Palliative Care Perspective. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2020_persp-19-00032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
This article explores the challenges of risk feeding from an Australian Paediatric Palliative Care perspective. There is currently limited evidence to guide risk feeding in pediatric clinical practice. Therefore, this article uses evidence from the adult palliative and end-of-life care context (extrapolating to pediatric application), in addition to the authors' clinical experience in supporting children and their families with risk feeding. Recommendations for the clinical management of pediatric risk feeding are discussed, including the suggested focus for families and the interprofessional team along the different phases of the palliative care continuum.
Conclusion
There is currently limited information to guide decision making regarding risk feeding in pediatrics. Overall, in the absence of evidence-based practice guidelines, it is the authors' recommendation that a risk feeding plan is developed in consultation and collaboration with the family, treating physician, and interprofessional team. Further research is required to support guidance for clinicians working in this area.
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Affiliation(s)
- Claire Radford
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Jeanne Marshall
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Anthony Herbert
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Helen Irving
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kelly Weir
- Gold Coast Hospital and Health Service, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Bowman OJ, Hagan JL, Toruno RM, Wiggin MM. Identifying Aspiration Among Infants in Neonatal Intensive Care Units Through Occupational Therapy Feeding Evaluations. Am J Occup Ther 2020; 74:7401205080p1-7401205080p9. [PMID: 32078519 PMCID: PMC7018452 DOI: 10.5014/ajot.2020.022137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE When a neonate's sucking, swallowing, and breathing are disorganized, oropharyngeal aspiration often occurs and results in illness, developmental problems, and even death. Occupational therapists who work in the neonatal intensive care unit (NICU) need to identify neonates who are at risk for aspirating so they can provide appropriate treatment. OBJECTIVE To ascertain whether client factors and performance skills of infants ages 0-6 mo during occupational therapy feeding evaluations are related to results of videofluoroscopic swallowing studies (VFSSs). DESIGN Retrospective chart reviews. SETTING 187-bed NICU in a nonprofit teaching hospital. PARTICIPANTS A purposive sample of 334 infants ages 0-6 mo, ≥33 wk gestational age at birth, admitted to a Level II, III, or IV NICU as defined by the American Academy of Pediatrics. OUTCOMES AND MEASURES Neonates were administered a feeding evaluation by an occupational therapist and a VFSS by a speech-language pathologist, which yielded information about client factors and performance skills. RESULTS Signs and symptoms of aspiration on the evaluations were significantly associated with VFSS results. Of 310 patients, 79 had silent aspiration. Of 55 infants who demonstrated no aspiration symptoms during the feeding evaluation, 45% demonstrated aspiration symptoms on the VFSS, and 55% aspirated on the VFSS but demonstrated no symptoms of aspiration. CONCLUSIONS AND RELEVANCE Aspiration among infants occurs inconsistently and depends on client factors, contexts, and environments. Occupational therapists are encouraged to assess an infant's feeding over several sessions to obtain a more accurate picture of the infant's feeding status. WHAT THIS ARTICLE ADDS This study provides information that helps occupational therapists identify infants at risk for aspiration and make optimal recommendations regarding safe feeding practices and appropriate referrals for a VFSS. Making appropriate referrals for VFSS is also important in preventing unnecessary exposure to radiation for preterm infants.
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Affiliation(s)
- O Jayne Bowman
- O. Jayne Bowman, OT, PhD, is Associate Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Joseph L Hagan
- Joseph L. Hagan, PhD, is Research Statistician, Center for Research and Evidence-Based Practice, Texas Children's Hospital, Houston
| | - Rose Marie Toruno
- Rose Marie Toruno, OTR, MOT, NDT/C, is Advanced Clinical Specialist, Texas Children's Hospital, Houston
| | - Mitzi M Wiggin
- Mitzi M. Wiggin, PT, MS, is Manager, Research and Clinical Education, Texas Children's Hospital, Houston
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McSweeney ME, Meleedy-Rey P, Kerr J, Chan Yuen J, Fournier G, Norris K, Larson K, Rosen R. A Quality Improvement Initiative to Reduce Gastrostomy Tube Placement in Aspirating Patients. Pediatrics 2020; 145:peds.2019-0325. [PMID: 31996405 PMCID: PMC6993527 DOI: 10.1542/peds.2019-0325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Oropharyngeal dysphagia and aspiration may occur in infants and children. Currently, there is wide practice variation regarding when to feed children orally or place more permanent gastrostomy tube placement. Through implementation of an evidence-based guideline (EBG), we aimed to standardize the approach to these patients and reduce the rates of gastrostomy tube placement. METHODS Between January 2014 and December 2018, we designed and implemented a quality improvement intervention creating an EBG to be used by gastroenterologists evaluating patients ≤2 years of age with respiratory symptoms who were found to aspirate on videofluoroscopic swallow study (VFSS). Our primary aim was to encourage oral feeding and decrease the use of gastrostomy tube placement by 10% within 1 year of EBG initiation; balancing measures included total hospital readmissions or emergency department (ED) visits within 6 months of the abnormal VFSS. RESULTS A total of 1668 patients (27.2%) were found to have aspiration or penetration noted on an initial VFSS during our initiative. Mean gastrostomy tube placement in these patients was 10.9% at the start of our EBG implementation and fell to 5.2% approximately 1 year after EBG initiation; this improvement was sustained throughout the next 3 years. Our balancing measures of ED visits and hospital readmissions also did not change during this time period. CONCLUSIONS Through implementation of this EBG, we reduced gastrostomy tube placement by 50% in patients presenting with oropharyngeal dysphagia and aspiration, without increasing subsequent hospital admissions or ED visits.
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Affiliation(s)
- Maireade E. McSweeney
- Aerodigestive Center and Motility and Functional Gastrointestinal Disorders Center, Division of Gastroenterology, Hepatology and Nutrition
| | | | | | | | - Gregory Fournier
- Aerodigestive Center and Motility and Functional Gastrointestinal Disorders Center, Division of Gastroenterology, Hepatology and Nutrition
| | - Kerri Norris
- Finance, Boston Children’s Hospital, Boston, Massachusetts
| | - Kara Larson
- Aerodigestive Center and Motility and Functional Gastrointestinal Disorders Center, Division of Gastroenterology, Hepatology and Nutrition
| | - Rachel Rosen
- Aerodigestive Center and Motility and Functional Gastrointestinal Disorders Center, Division of Gastroenterology, Hepatology and Nutrition
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