Infant Videofluoroscopic Swallow Study Testing, Swallowing Interventions, and Future Acute Respiratory Illness

Abstract

OBJECTIVES: Tube feedings are commonly prescribed to infants with swallowing abnormalities detected by videofluoroscopic swallow study (VFSS), but there are no studies demonstrating efficacy of these interventions to reduce risk of acute respiratory illness (ARI). We sought to measure the association between swallowing interventions and future ARI, among VFSS-tested infants. METHODS: Retrospective cohort of all infants (<12 months) tested with VFSS at a children’s hospital between January 1, 2010, and January 1, 2012. Hospital ARI encounters (emergency, observation, or inpatient status) in a 22-hospital integrated health care delivery system, between the first VFSS and age 3 years, were measured. VFSS results were grouped by normal, intermediate, and oropharyngeal aspiration (OPA), with OPA further subdivided by silent versus cough and thin versus thick liquid OPA. Cox regression modeled the association between swallowing interventions (thickened or nasal tube feedings) and ARI, accounting for changes in swallowing and interventions over time. RESULTS: 576 infants were tested with a VFSS in their first year of life, receiving a total of 1051 VFSSs in their first 3 years of life. More than 60% of infants received a measured feeding intervention. With the exception of infants with silent OPA who received thickened feedings, neither thickening nor nasal tube feedings, compared with no intervention, were associated with a decreased risk of subsequent ARI. CONCLUSIONS: Swallowing interventions and repeated testing are common among VFSS-tested infants. However, the importance of diagnosing and intervening on VFSS-detected swallowing abnormalities for the majority of tested infants remains unclear.

Feeding Interventions Are Associated With Improved Outcomes in Children With Laryngeal Penetration

“…Jackson showed symptom improvements from feeding interventions in a population of Down syndrome patients with aspiration (30). Coon questioned the benefits of thickening for oropharyngeal dysphagia patients but found decreased acute respiratory hospitalizations for children with silent aspiration that received thickening (31). Khoshoo showed that thickening decreased the occurrence of aspiration in a small group of infants with swallowing dysfunction associated with bronchiolitis (32,33).…”

Presenting Signs and Symptoms do not Predict Aspiration Risk in Children

“…Relatively few studies have examined the presentation and epidemiology of swallowing dysfunction in young children; this remains both an under-studied and under-appreciated area in clinical pediatrics and the prevalence of oropharyngeal dysphagia appears to be increasing due to increased survival of premature infants and other children with chronic medical problems 2, 28, 29 . We focused our study on infants and children under age 2 because this group has the highest rate of oropharyngeal dysphagia of any pediatric age group.…”

Feeding Problems and Their Underlying Mechanisms in the Esophageal Atresia–Tracheoesophageal Fistula Patient

“…Studies in both children and adults have shown that thicker liquids alter the temporal characteristics of swallowing, especially closure of the true vocal cords, and lengthen deglutition time (63, 64). In a retrospective study of 546 infants, children with silent aspiration had fewer acute respiratory infections requiring admission or emergency room visits when receiving thickened feeds than those without thickening (65). In a study of 15 infants with respiratory syncytial virus bronchiolitis, 9 were found to have abnormal VFSS studies (laryngeal or tracheal penetration or aspiration) with thin barium.…”