Dysphagia intervention in NICU set up: a report of case studies in an Indian public hospital

Abstract

<p class="abstract">A retrospective study was conducted in the Neonatal Intensive Care Unit (NICU) of a public hospital in Mumbai, India wherein 13 neonates with varying pathophysiologies were taken up for swallowing intervention. Of these, 7 neonates had history of prematurity, 1 was born of twin birth with prematurity, 3 had clefts of lip/palate and 2 had Pierre Robin Syndrome. For 7 neonates with prematurity, the swallowing regimen consisted of oro motor intervention (OMI) followed with therapeutic oral feeds. With improved tolerance of oral feeds while maintaining airway safety, they were graduated to oral feeds progressively increasing in volume until they reached optimum prescribed oral feeds. 6 out of 7(86%) progressed to breast feeds while1 succumbed to medical complications. 3 babies with CLP graduated to complete oral feeds through bondla, when they were fitted with obturators and had swallowing intervention but were unable to move to breastfeeds while in NICU. 2 babies with PRS could not tolerate oral feeds even after multiple sessions and had to be maintained on orogastric feeds. 1 infant, one of a twin delivery with prematurity although was showing improvement to OMI succumbed to medical complications. Among these neonates, those with prematurity showed the maximum improvement with swallowing intervention followed by infants with CLP. Co-morbidities such as prematurity in twin births worsened the prognosis as did a disorder such as PRS. This preliminary study, done on a small sample, stressed the importance of swallowing intervention in neonates with high risk factors by the SLP in the NICU in an Indian set up. </p>