Short-Term Effects of Cold Liquids on the Pharyngeal Swallow in Preterm Infants with Dysphagia: A Pilot Study.

Cold stimulation reduces airway compromise in adults with dysphagia. However, there is no sufficient evidence to support its use in the pediatric population. The primary goal of this pilot study is to assess the effect of cold liquid on the pharyngeal swallow mechanism in preterm infants with dysphagia. We hypothesized that thermal stimulation from cold liquid will decrease the risk of airway compromise in dysphagic preterm infants. Nine preterm infants with clinical symptoms of dysphagia were included. Video fluoroscopic swallow studies were used to assess the swallowing mechanism of each participant. The occurrence of swallow dysfunctions under room temperature liquid swallows (RTS) vs. short period cold liquid swallows (CS) was compared. Paired t test was used to test significance. The occurrence of deep penetration (p = 0.007) and aspiration (p = 0.002) decreased significantly in the CS condition compared with the RTS condition. There was a trend of less nasopharyngeal reflux with CS but did not reach statistical significance (p = 0.084). No differences were noted for mild penetration (p = 0.824). CS reduced airway compromise in dysphagic preterm infants compared to RTS. These data provide important information regarding the immediate effects of CS on pharyngeal swallowing in preterm infants with dysphagia. However, further investigation regarding its sustained effects is required before introducing to clinical practice.

Development of an Oral Care Multidisciplinary Initiative in an Acute Care Community Hospital: Framework, Timeline, and Outcomes.

Purpose Published literature universally supports the provision of oral care in acute care settings to decrease hospital-acquired aspiration pneumonia (HAAP) events. This evidence-based practice project aimed to implement a comprehensive oral care initiative to reduce a problematic HAAP rate. Method Through a comprehensive, multidisciplinary approach, the project scope included an assessment of the current state of oral care delivery, development of an Oral Care Task Force, creation of risk stratification criteria with recommended oral care products, and robust education for the clinical staff. Data were gathered using a small convenience sample of inpatients and hospital-wide HAAP rates. Results Over the 1 year of implementation and education associated with this multidisciplinary project, the organization saw an increase in oral care tools being available to patients and staff at the bedside, an increase in patients' awareness of oral care tools in their rooms, and a decrease in the overall HAAP rate. Conclusions Creating a multidisciplinary team within an acute care organization with a focus on oral care delivery can be substantially advantageous to patients and hospitals alike. Although this project was limited in its analysis, the demonstrated results are nonetheless interesting and may be applicable to other acute care settings. Ultimately, attention to the importance of oral care and consistent care delivery can provide improved patient outcomes.