Capturing infant swallow impairment on videofluoroscopy: timing matters.
Pediatr Radiol
; 50(2): 199-206, 2020 02.
Article
em En
| MEDLINE
| ID: mdl-31650190
ABSTRACT
BACKGROUND:
Infant videofluoroscopic swallow studies (VFSSs) require clinicians to make determinations about swallowing deficits based on a limited number of fluoroscopically observed swallows. Although airway protection is known to decline throughout a bottle-feed, the paucity of data regarding the timing of this degradation has limited the development of procedural protocols that maximize diagnostic validity.OBJECTIVE:
We tested the stability of key components of swallow physiology and airway protection at four standardized timepoints throughout the VFSS. MATERIALS ANDMETHODS:
Thirty bottle-fed infants with clinical signs of swallow dysfunction underwent VFSS. Fluoroscopy was turned on to allow visualization of five swallows at 000, 030, 130 and 230 (minutesseconds [mins]). We evaluated swallows for components of swallow physiology (oral bolus hold, initiation of pharyngeal swallow, timing of swallow initiation) and airway protection (penetration, aspiration). We used model-based linear contrasts to test differences in the percentage of swallows with low function component attributes.RESULTS:
All components of swallow physiology exhibited a change throughout the VFSS (P≤0.0005). Changes were characterized by an increase in the number of sucks per swallow (P<0.0001), percentage of swallows with incomplete bolus hold (P=0.0005), delayed initiation of pharyngeal swallow (P<0.0001), delayed timing of swallow initiation (P=0.0004) and bolus airway entry (P<0.0001). These findings demonstrate that infants with dysphagia exhibit a change in swallow physiology throughout the videofluoroscopic swallow exam.CONCLUSION:
Fluoroscopic visualization that is confined to the initial swallows of the bottle feed limit the exam's diagnostic validity. Developing evidence-based procedural guidelines for infant VFSS execution is crucial for maximizing the exam's diagnostic and treatment yield.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Transtornos de Deglutição
Tipo de estudo:
Guideline
/
Prognostic_studies
Limite:
Female
/
Humans
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Infant
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Male
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article