Lung ultrasound in young children with neurological impairment: A proposed integrative clinical tool for deaeration-detection related to feeding

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.

Lung ultrasound supports clinical evaluation of feeding competence development in preterm neonates

“…Differently than reported in infants and toddlers ( 8 ), in our neonatal population LUS before and after meal did not show significantly different results. We interpreted this result considering a few aspects.…”

“…These aspects encourage potential applications of the LUS technique for non-invasive, infant-friendly study in fragile populations such as newborns and infants. These has been recently addressed by our group supporting the usefulness of LUS to identify pulmonary abnormalities potentially related to feeding difficulties in infants and young children with neurological impairment (8,9). In this direction, infants born preterm or newborns with other comorbidities that may impact feeding abilities may represent a potential target to promote a further use of LUS.…”

“…Our research group reported previous encouraging results in detecting silent and overt inhalation related to the meal in children with cerebral palsy or other encephalopathies leading to dysphagia/gastroesophageal reflux disease (GERD) ( 8 ) and designed a randomized controlled trial in order to investigate LUS-monitored meals evaluation and feeding management in infants aged 0–6 years with neurodevelopmental delay, the LUNCH Study (ClinicalTrials.gov Identifier: NCT04253951) ( 9 ).…”