Aspiration in the First Year of Life and Later Tube Feeding: A Retrospective Cohort from a Low-Income Country.

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.

Instrumental Swallowing Assessments in the Neonatal and Pediatric Populations: A Systematic Review.

The scientific scope of swallowing disorders in the neonatal and pediatric populations is growing exponentially; however, the preponderance of evidence for evaluation protocols has been concentrated in non-instrumental evaluations creating a lack of research about protocols for instrumental swallowing assessment. Thus, the purpose of this study was to systematically review the literature to identify and to report protocols used in instrumental assessments through videofluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) in the neonatal and pediatric populations to support clinical decision making. The search strategy was applied in five online databases, no filters were applied to restrict languages or publication dates and the gray literature was reviewed. PRISMA statement was used to guide the construction of this review. The studies included validated and unvalidated protocols, the validated protocols had their risk of bias estimated using the QUADAS-2. In total, 13 studies were included in the final review, of these eleven assessed through QUADAS-2, and two classified with low risk of bias. One study is in the process of standardization and validation of an instrumental assessment protocol for swallowing in bottle-fed infants through VFSS. Information about validity and reliability of published protocols for instrumental evaluation in the neonatal and pediatric populations is limited. Therefore, further research is needs to development studies aiming to standardize and validate protocols for instrumental assessments in these populations.

Interventions in the Alteration on Lingual Frenum: Systematic Review.

INTRODUCTION: Altered lingual frenum modifies the normal tongue mobility, which may influence the stomatognathic functions, resulting in anatomical, physiological and social damage to the subject. It is necessary that health professionals are aware of the process of evaluation, diagnostics and treatment used today, guiding their intervention. OBJECTIVE: To perform a systematic review of what are the treatment methods used in cases of lingual frenum alteration. DATA SYNTHESIS: The literature searches were conducted in MEDLINE, LILACS, SciELO, Cochrane and IBECS, delimited by language (Portuguese, English, Spanish), date of publication (January 2000 to January 2014) and studies performed in humans. The selection order used to verify the eligibility of the studies were related to: full text availability; review the abstract; text analysis; final selection. Of the total 443 publications, 26 remained for analysis. The surgical approach was used in all studies, regardless of the study population (infants, children and adults), with a range of tools and techniques employed; speech therapy was recommended in the post surgical in 4 studies. Only 4 studies, all with infants, showed scientific evidence. CONCLUSION: Surgical intervention is effective for the remission of the limitations caused by the alteration on lingual frenum, but there is a deficit of studies with higher methodological quality. The benefits of speech therapy in the post surgical period are described from improvement in the language of mobility aspects and speech articulation.

Interventions in the Alteration on Lingual Frenum: Systematic Review

Abstract Introduction Altered lingual frenum modifies the normal tongue mobility, which may influence the stomatognathic functions, resulting in anatomical, physiological and social damage to the subject. It is necessary that health professionals are aware of the process of evaluation, diagnostics and treatment used today, guiding their intervention. Objective To perform a systematic review of what are the treatment methods used in cases of lingual frenum alteration. Data Synthesis The literature searches were conducted in MEDLINE, LILACS, SciELO, Cochrane and IBECS, delimited by language (Portuguese, English, Spanish), date of publication (January 2000 to January 2014) and studies performed in humans. The selection order used to verify the eligibility of the studies were related to: full text availability; review the abstract; text analysis; final selection. Of the total 443 publications, 26 remained for analysis. The surgical approach was used in all studies, regardless of the study population (infants, children and adults), with a range of tools and techniques employed; speech therapy was recommended in the post surgical in 4 studies. Only 4 studies, all with infants, showed scientific evidence. Conclusion Surgical intervention is effective for the remission of the limitations caused by the alteration on lingual frenum, but there is a deficit of studies with higher methodological quality. The benefits of speech therapy in the post surgical period are described from improvement in the language of mobility aspects and speech articulation.

Análise das desigualdades socioeconômicas na cobertura da vacina contra difteria, tétano e coqueluche (DTP)/ tetravalente para menores de 1 ano de idade no Rio Grande do Sul, 2000-2009* / Socioeconomic inequalities in DTP+Hib immunization coverage among children under one year-old, in Rio Grande do Sul state, Brazil, 2000-2009

Objetivo: analisar tendências nas disparidades socioeconômicas e sua associação com a cobertura vacinal contra difteria, tétano e coqueluche (DTP)/tetravalente no estado do Rio Grande do Sul. Métodos: foi construída uma série histórica da cobertura da vacinal para os 496 municípios do estado, compreendendo 2000 a 2009; os municípios foram agrupados nos tercis de seis variáveis socioeconômicas (renda; indigência; escolaridade; produto interno bruto (PIB) per capita; investimentos em saúde; e proporção de mães jovens) e calculou-se a cobertura segundo tercil. Resultados: as taxas de cobertura diminuíram de 110,8 para 104,5 doses/100 nascidos vivos, no período; o percentual de municípios que atingiram a meta (cobertura >95 por cento) reduziu-se de 72,8 para 61,5 por cento; não houve diferenças na tendência de cobertura entre os tercis de qualquer das variáveis socioeconômicas investigadas. Conclusão: as diferenças na cobertura ao longo do tempo flutuaram aleatoriamente, com fraca tendência de declínio, e não estiveram associadas às variáveis socioeconômicas municipais investigadas.

Objective: to analyse socioeconomic trends in DTP+Hib vaccination coverage in the state of Rio Grande do Sul. Methods: time series coverage of DTP+Hib vaccine for all 496 municipalities for the years 2000 to 2009. The municipalities were then grouped into tertiles of six socioeconomic variables and coverage was calculated for each group. Results: the rates of DTP+Hib vaccine coverage decreased from 110.8 to 104.5 doses/100 live births from 2000 to 2009. The percentage of municipalities reaching the target (coverage >95 per cent) decreased from 72.8 per cent to 61.5 per cent. There were no coverage trend differences between tertiles in any of the socioeconomic variables over time (chi-square test, p>0.05). Conclusion: coverage trends over time fluctuated randomly with a slight tendency to decrease. Policies aimed at municipalities achieving vaccination coverage goals should focus on factors other than municipal socioeconomic characteristics.