Sensory-Motor-Oral Stimulation Combined with Early Sucking During the Mandibular Distraction Osteogenesis Process in Children with Robin Sequence.

OBJECTIVE: To describe the findings of children with Robin Sequence (RS) who received sensory-motor-oral stimulation combined with early sucking during mandibular distraction osteogenesis (MDO), compared with children who did not receive the intervention. DESIGN: A quasi-experimental study. Setting: A tertiary public hospital. Patients: Children with RS referred to MDO. A historical group from the same population but managed according to the institution's standard protocol (no sucking) served as a control group. Interventions: Sensory-motor-oral stimulation, including sucking, starting 24 h after MDO (intervention group). Main Outcome Measure: Our hypothesis is that sensory-motor-oral stimulation, including sucking during the DOM process, do not negatively affect surgical outcomes. RESULTS: Twenty-nine children were included. Eight (72.7%) of the 11 patients in the intervention group and 13 (72.2%) of the 18 controls had MDO complications, with no significant difference between the groups (p = 1.000). The most common surgical outcome was antibiotic therapy for surgical site infection (76.2%). Six months after MDO, 22 (75.9%) children attained full oral feeding or associated with alternative feeding methods. CONCLUSION: The intervention group did not have higher complication rates, from a surgical point of view, than control group. The protocol adopted by some centers that contraindicates sucking during MDO should be revised to consider the benefits of such stimulation. Keywords: Pierre Robin Syndrome, deglutition, therapeutics, child development.

Clinical outcomes before and after videofluoroscopic swallow study in children 24 months of age or younger.

OBJECTIVE: To evaluate the combined impact of videofluoroscopic swallow study (VFSS) and therapeutic feeding and swallowing interventions on clinical outcomes in children with oropharyngeal dysphagia (OPD). METHODS: This was an uncontrolled longitudinal analytical study in which OPD patients were evaluated before and after VFSS. Children ≤ 24 months of age diagnosed with OPD in a clinical setting and undergoing VFSS for investigation and management of OPD were included in the study. The study participants received therapeutic feeding and swallowing interventions after having undergone VFSS, being followed at an outpatient clinic for pediatric dysphagia in order to monitor feeding and swallowing difficulties. Respiratory and feeding outcomes were compared before and after VFSS. RESULTS: Penetration/aspiration events were observed in 61% of the VFSSs (n = 72), and therapeutic feeding and swallowing interventions were recommended for 97% of the study participants. After the VFSS, there was a reduction in the odds of receiving antibiotic therapy (OR = 0.007) and in the duration of antibiotic therapy (p = 0.014), as well as in the odds of being admitted to hospital (p = 0.024) and in the length of hospital stay (p = 0.025). A combination of oral and enteral feeding became more common than oral or enteral feeding alone (p = 0.002). CONCLUSIONS: A high proportion of participants exhibited penetration/aspiration on VFSS. Therapeutic feeding and swallowing interventions following a VFSS appear to be associated with reduced respiratory morbidity in this population.

Clinical outcomes before and after videofluoroscopic swallow study in children 24 months of age or younger / Desfechos clínicos antes e depois da videofluoroscopia da deglutição em crianças com 24 meses de idade ou menos

ABSTRACT Objective: To evaluate the combined impact of videofluoroscopic swallow study (VFSS) and therapeutic feeding and swallowing interventions on clinical outcomes in children with oropharyngeal dysphagia (OPD). Methods: This was an uncontrolled longitudinal analytical study in which OPD patients were evaluated before and after VFSS. Children ≤ 24 months of age diagnosed with OPD in a clinical setting and undergoing VFSS for investigation and management of OPD were included in the study. The study participants received therapeutic feeding and swallowing interventions after having undergone VFSS, being followed at an outpatient clinic for pediatric dysphagia in order to monitor feeding and swallowing difficulties. Respiratory and feeding outcomes were compared before and after VFSS. Results: Penetration/aspiration events were observed in 61% of the VFSSs (n = 72), and therapeutic feeding and swallowing interventions were recommended for 97% of the study participants. After the VFSS, there was a reduction in the odds of receiving antibiotic therapy (OR = 0.007) and in the duration of antibiotic therapy (p = 0.014), as well as in the odds of being admitted to hospital (p = 0.024) and in the length of hospital stay (p = 0.025). A combination of oral and enteral feeding became more common than oral or enteral feeding alone (p = 0.002). Conclusions: A high proportion of participants exhibited penetration/aspiration on VFSS. Therapeutic feeding and swallowing interventions following a VFSS appear to be associated with reduced respiratory morbidity in this population.

RESUMO Objetivo: Avaliar o impacto conjunto da videofluoroscopia da deglutição (VFD) e intervenções terapêuticas de alimentação e deglutição nos desfechos clínicos em crianças com disfagia orofaríngea (DOF). Métodos: Trata-se de um estudo analítico longitudinal não controlado em que pacientes com DOF foram avaliados antes e depois da VFD. Foram incluídas no estudo crianças com idade ≤ 24 meses e diagnóstico clínico de DOF, submetidas à VFD para a investigação e manejo da DOF. Os participantes do estudo receberam intervenções terapêuticas de alimentação e deglutição após terem sido submetidos à VFD, sendo então acompanhados em um ambulatório de disfagia pediátrica para o monitoramento das dificuldades de alimentação e deglutição. Os desfechos respiratórios e alimentares foram comparados antes e depois da VFD. Resultados: Eventos de penetração/aspiração foram observados em 61% das VFD (n = 72), e intervenções terapêuticas de alimentação e deglutição foram recomendadas a 97% dos participantes do estudo. Após a VFD, houve uma redução das chances de receber antibioticoterapia (OR = 0,007) e da duração da antibioticoterapia (p = 0,014), bem como das chances de internação hospitalar (p = 0,024) e do tempo de internação (p = 0,025). A alimentação por via oral e enteral em conjunto tornou-se mais comum do que a alimentação exclusivamente por via oral ou enteral (p = 0,002). Conclusões: Houve alta proporção de crianças que apresentaram penetração/aspiração na VFD. As intervenções terapêuticas de alimentação e deglutição após a VFD parecem estar associadas à redução da morbidade respiratória nessa população.

Therapeutic Management with Airway Clearance in Children with Robin Sequence and Association with Swallowing Outcomes: A Systematic Review and Meta-analysis.

Dysphagia in Robin Sequence can be present in varying degrees, requiring multidisciplinary management and specific swallowing assessment by a specialist. Most studies published to date have evaluated only respiratory outcomes, and the available evidence on the improvement of swallowing is questionable. To conduct a systematic review and meta-analysis of studies evaluating swallowing in children with Robin Sequence before and after airway clearance procedures. The research question was developed based on the PICO strategy. The literature search was performed in electronic databases and gray literature. Studies were selected by 3 independent reviewers. The risk of bias and level of evidence of the studies were assessed. A proportion meta-analysis was performed to calculate the prevalence of dysphagia after airway clearance procedures. The search identified 4938 studies, 5 of which were included. All studies had limitations in terms of design and sample size. The prevalence of dysphagia after airway clearance was obtained by analyzing treatment subgroups: mandibular distraction osteogenesis, mandibular distraction osteogenesis + tracheostomy tube, and nasopharyngeal tube. Clinical and/or instrumental assessment was assessed by a swallowing specialist. The meta-analysis was precluded by the limitations of the studies, especially regarding sample size, which affected the accuracy of the findings. Dysphagia remained unresolved in 55% of children (95% CI 1-99%). The methodological quality of the studies indicated a high risk of bias and very low level of evidence. It was not possible to confirm that airway clearance techniques used in Robin Sequence improve dysphagia.

Accuracy of clinical swallowing evaluation for diagnosis of dysphagia in children with laryngomalacia or glossoptosis.

OBJECTIVE: To investigate the accuracy of clinical evaluation of swallowing in a sample of children with laryngomalacia or glossoptosis and describe the prevalence of dysphagia in each of these diseases, as well as characterize the swallow response to speech and language therapy interventions. STUDY DESIGN: Children aged 1 month to 11 years receiving care at the Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Brazil, were evaluated in a cross-sectional design. Evaluation of swallowing was performed at two time points by two blinded speech-language pathologists, one responsible for clinical evaluation and the other for videofluoroscopic study. The protocols employed were based on the instruments proposed by DeMatteo et al. (DeMatteo C, Matovich D, Hjartarson A. Comparison of clinical and videofluoroscopic evaluation of children with feeding and swallowing difficulties. Dev Med Child Neurol 2005;47:149-157.). RESULTS: The study sample consisted of 29 patients: 10 patients with laryngomalacia and 19 patients with glossoptosis. The sensitivity of clinical evaluation did not exceed 50% in any of the evaluations, but specificity reached 100% in some cases, using thickened liquids. The prevalence of dysphagia was 100%, and the use of thickened liquids significantly reduced tracheal aspiration. CONCLUSIONS: Dysphagia was highly prevalent in this sample. The sensitivity of clinical evaluation to detect laryngeal penetration and tracheal aspiration was low, as the majority of aspiration events were silent. The videofluoroscopic study is important in order to determine a safest method to feed the patient. Pediatr Pulmonol. 2017;52:41-47. © 2016 Wiley Periodicals, Inc.

Severity of clinical manifestations and laryngeal exposure difficulty predicted by glossoptosis endoscopic grades in Robin sequence patients.

OBJECTIVE: To evaluate the performance of two glossoptosis airway obstruction classifications in predicting symptom severity and laryngeal exposure difficulty in Robin Sequence (RS) patients. SETTING: Public tertiary hospital otolaryngology section (Hospital de Clínicas de Porto Alegre - HCPA). PATIENTS: All RS patients diagnosed at HCPA from October 2012 to February 2015 were enrolled, a total of 58 individuals. They were classified in isolated RS, RS-Plus and syndromic RS. INTERVENTION: Patients were submitted to sleep endoscopy and a score was attributed according to Yellon and de Sousa by a blinded researcher. Symptom severity evaluation was performed as defined by Cole classification. MAIN OUTCOME MEASURE: Association between endoscopic findings and clinical symptoms severity and laryngeal exposure difficulty. RESULTS: Twenty four patients were identified as isolated RS (41.4%), 19 patients presented as RS-Plus (32.7%) and 15 patients had well defined diagnosed syndromes (25.9%). Concomitant airway anomalies were found in 18 patients (31%). Specifically 17.4% in isolated RS, 55.6% in RS- Plus and 28.6% in the syndromic group had such anomalies (P = 0,03). Probability of presenting severe clinical symptoms as graded by Cole was higher in grade 3 Yellon classification (68.4%, P = 0.012) and in moderate and severe de Sousa classification (61.5% and 62.5%, respectively, P = 0.015) than in milder grades of obstruction. This findings were considered significant even after controlling for patient age. Laryngeal exposure difficulty was correlated with de Sousa and Yellon (Rho = 0,41 and Rho = 0,43, respectively; P < 0,05). CONCLUSION: Patients with higher degrees of obstruction in sleep endoscopy had a higher probability of presenting a more severe clinical manifestation and a more difficult laryngeal exposure. Since the number of patients included in this study was small for subgroup analyses, it is not clear if this association is restricted to a specific group of RS.

Evaluation of swallowing in infants with congenital heart defect.

Introduction Surgical repair of congenital heart disease in the first years of life compromises the coordination of the suction, breathing, and swallowing functions. Objective To describe the alterations in swallowing found in infants with congenital heart defect during their hospitalization. Methods Prospective, cross-sectional study in a reference hospital for heart disease. The sample consisted of 19 postsurgical patients who underwent an evaluation of swallowing. The infants included were younger than 7 months and had a diagnosis of congenital heart defect and suspected swallowing difficulties. Results Of the 19 infants with congenital heart defect, the median age was 3.2 months. A significant association was found between suction rhythm and dysphagia (p = 0.036) and between oral-motor oral feeding readiness and dysphagia (p = 0.014). Conclusions The data suggest that dysphagia often occurs after surgery in infants with congenital heart defect. Infants with congenital heart defect had very similar behavior to preterm infants in terms of oral feeding readiness.

Evaluation of Swallowing in Infants with Congenital Heart Defect

Introduction Surgical repair of congenital heart disease in the first years of life compromises the coordination of the suction, breathing, and swallowing functions. Objective To describe the alterations in swallowing found in infants with congenital heart defect during their hospitalization. Methods Prospective, cross-sectional study in a reference hospital for heart disease. The sample consisted of 19 postsurgical patients who underwent an evaluation of swallowing. The infants included were younger than 7 months and had a diagnosis of congenital heart defect and suspected swallowing difficulties. Results Of the 19 infants with congenital heart defect, the median age was 3.2 months. A significant association was found between suction rhythm and dysphagia (p = 0.036) and between oral-motor oral feeding readiness and dysphagia (p = 0.014). Conclusions The data suggest that dysphagia often occurs after surgery in infants with congenital heart defect. Infants with congenital heart defect had very similar behavior to preterm infants in terms of oral feeding readiness. .

Comportamento motor oral e global de recém-nascidos de mães usuárias de crack e/ou cocaína / Oral and general motor behavior of newborns from crack and/or cocaine using mothers

OBJETIVO: Analisar o comportamento motor oral e global de recém-nascidos de mães que fizeram uso de crack e/ou cocaína durante a gestação e verificar se há relação entre o desenvolvimento dos sistemas sensório motor oral (SSMO) e motor global. MÉTODOS: Estudo transversal, em que foram avaliados 25 recém-nascidos prematuros e a termo de mães usuárias de crack e/ou cocaína, pareados com outro grupo de 25 recém-nascidos sem o fator em estudo. As avaliações do SSMO e motor global foram realizadas por meio do Instrumento de Avaliação da Prontidão do Prematuro para Início da Alimentação Oral e do Test of Infant Motor Performance (TIMP), respectivamente. Os resultados compararam os escores encontrados nas duas escalas e a relação destes com o uso materno do crack e/ou cocaína durante a gestação. RESULTADOS: No TIMP não foi constatada diferença na comparação entre os escores de recém-nascidos de mães usuárias de crack e/ou cocaína e os de mães não usuárias. No Instrumento de Avaliação da Prontidão do Prematuro para Início da Alimentação Oral, os resultados apresentaram diferença. Foi observada associação entre os resultados de bebês que apresentaram atraso no TIMP com menor escore no Instrumento de Avaliação da Prontidão do Prematuro para Início da Alimentação Oral. CONCLUSÃO: O baixo desempenho observado no Instrumento de Avaliação da Prontidão do Prematuro para Início da Alimentação Oral sugere que as respostas motoras orais estão alteradas pelo uso materno das drogas. A correlação entre os dois instrumentos mostra que o desenvolvimento do SSMO pode estar relacionado ao desenvolvimento motor global.

PURPOSE: analyzing the oral and general motor behavior of newborns from women who used crack and/or cocaine during pregnancy, and verifying if there is a relation between the development of the oral and general sensory motor system. METHODS: Cross-sectional study with 25 premature and full-term newborns from women who were crack and/or cocaine users were compared with another group composed of 25 newborns without the studied factor. The evaluations of the oral and general sensory motor system were carried out by the Instrument to Assess the Readiness of Preterm Infants for Oral Feeding and by the Test of Infant Motor Performance (TIMP). The results compared the scores obtained in both scales and their relation to the use of crack and/or cocaine during pregnancy. RESULTS: No significant difference was found by the TIMP when comparing the newborns from crack and/or cocaine-using mothers to the ones from non-using mothers. The results from the Instrument to Assess the Readiness of Preterm Infants for Oral Feeding showed statistic significance. A significant relation between the results from babies who presented delay in the TIMP to the lowest score in the Instrument to Assess the Readiness of Preterm Infants for Oral Feeding was observed. CONCLUSION: The low performance observed in the Instrument to Assess the Readiness of Preterm Infants for Oral Feeding suggests that the oral motor responses are altered by the use of drugs during the pregnancy. The significant correlation between both instruments shows that the development of the oral sensory motor system is directly related to the general motor development.

Psychometric properties of the international outcome inventory for hearing AIDS.

UNLABELLED: It is paramount to assess the psychometric properties of self-assessment tools in order to check the tests' reliability and validity, also to enable proper outcome interpretation. AIM: to check the psychometric properties of the IOI-HA (International Outcome Inventory for Hearing Aids) in its Portuguese version, called QI-AASI (International Questionnaire - Individual Sound Amplification Device), in terms of internal uniformity, correlation between the items and reproducibility. STUDY DESIGN: descriptive, observational and cross-sectional. MATERIALS AND METHODS: the questionnaire was deployed to 53 hearing aid users, 34 females and 19 males, with ages between 19 and 92 years - from incomplete basic education to complete higher education, encompassing subjects with monoaural and binaural sound amplification. RESULTS: the QI-AASI had a Cronbach Alpha of 0.69. In the correlation among the items, there were numerous significant correlations. The instrument was properly reproducible, except for item # 6, which presented a significant difference in comparing test and the retest. CONCLUSIONS: the QI-AASI is suggested in the rehabilitation process of users of hearing aides; nonetheless, the questionnaire can be difficult for subjects with low social and economic status when self-employed.

Propriedades psicométricas do questionário internacional: aparelho de amplificação sonora individual / Psychometric properties of the international otcome inventory for hearing AIDS

Analisar as propriedades psicométricas de instrumentos de autoavaliação é primordial para verificar a confiabilidade e a validade dos testes, além de permitir a interpretação correta dos resultados. Objetivo: Verificar as propriedades psicométricas do IOI-HA (International Outcome Inventory for Hearing Aids) na versão em português, denominada QI-AASI (Questionário Internacional - Aparelho de Amplificação Sonora Individual), em termos de consistência interna, correlação entre os itens e reprodutibilidade. Forma de estudo: Descritivo, observacional e transversal. Material e método: O questionário foi aplicado em 53 usuários de AASI, 34 do sexo feminino e 19 do sexo masculino, com idades compreendidas entre 19 e 92 anos e nível de instrução de ensino básico incompleto a ensino superior completo, abrangendo sujeitos com amplificação binaural e monoaural. Resultados: O QI-AASI apresentou um Alpha de Cronbach em 0,69. Na correlação entre os itens foram verificadas várias correlações significativas. O instrumento se reproduziu de forma adequada, exceto para o item 6, que apresentou diferença significativa na comparação entre o teste e o reteste. Conclusões: Sugere-se o uso do QI-AASI no processo de reabilitação de usuários de prótese (s) auditiva (s), porém considera-se que o questionário pode ser de difícil compreensão para sujeitos com baixo nível sociocultural na situação autoaplicada.

It is paramount to assess the psychometric properties of self-assessment tools in order to check the tests' reliability and validity, also to enable proper outcome interpretation. AIM: to check the psychometric properties of the IOI-HA (International Outcome Inventory for Hearing Aids) in its Portuguese version, called QI-AASI (International Questionnaire - Individual Sound Amplification Device), in terms of internal uniformity, correlation between the items and reproducibility. Study design: descriptive, observational and cross-sectional. Materials and methods: the questionnaire was deployed to 53 hearing aid users, 34 females and 19 males, with ages between 19 and 92 years - from incomplete basic education to complete higher education, encompassing subjects with monoaural and binaural sound amplification. Results: the QI-AASI had a Cronbach Alpha of 0.69. In the correlation among the items, there were numerous significant correlations. The instrument was properly reproducible, except for item # 6, which presented a significant difference in comparing test and the retest. Conclusions: the QI-AASI is suggested in the rehabilitation process of users of hearing aides; nonetheless, the questionnaire can be difficult for subjects with low social and economic status when self-employed.