Validity of Clinical Indices of Feeding Performance at Detecting Swallow Study Results in Preterm Infants
2023-05
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Validity of Clinical Indices of Feeding Performance at Detecting Swallow Study Results in Preterm Infants
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2023-05
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Background: Premature infants experience high rates of dysphagia and often undergo feeding assessments to identify deficits and evaluate the potential effectiveness of therapeutic interventions. Interestingly, little is known regarding whether or not the presence of these deficits is a good indicator of whether or not an infant is experiencing penetration or aspiration. In this investigation we examined how well various clinical markers of feeding impairment identify preterm infants who are found to exhibit penetration or aspiration on videofluoroscopic swallow exam. Methods: Preterm infants with dysphagia (as characterized by reliance on alternative nutrition or reports of clinical feeding difficulties) were recruited for this investigation. Clinical symptoms of consented infants were recorded, followed by the completion of a VFSS with concurrent video recording of their face and cardiorespiratory monitor (pulse oximeter) when available. VFSS exams were analyzed using BaByVFSSImP and concurrent videos were analyzed using the Early Feeding Skills assessment. Results are reported with descriptive statistics as mean ± standard deviation and N (proportion). Results: Thirty-one preterm infants born at 31.4 土3.23 weeks gestation underwent VFSS at 41.2 土 7.11 weeks PMA. The VFSS was clinically indicated in 39% of the patients. The majority of infants were reported to have fatigue with feeds (77%), with fewer infants exhibiting cardiopulmonary instability with feeds (16%) or coughing (23%). Bolus airway entry was observed in 65% of infants but primarily restricted to penetration (59%) with aspiration only observed in 2 infants (6%). Signs of feeding impairment did not strongly predict infants who aspirated (PPV: 0-20%), however it did provide a stronger predictor of penetration (PPV: 40-71%). Absence of signs of feeding impairment strongly signified the presence of airway protection (NPV: 31-42%). Clinical signs of impairment that were reported prior to the VFSS were only seen in 10% of infants during the VFSS exam. Conclusion:
The majority of signs of feeding impairment provide little information regarding the presence or absence of penetration or aspiration on VFSS when viewed in isolation. The presence of coughing provides the highest predictive value, though its absence does not guarantee airway protection is complete. Future investigations examining how the presence of multiple symptoms may better predict infants who exhibit penetration or aspiration (bolus airway entry) are warranted.
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University of Minnesota M.A. thesis. May 2023. Major: Speech-Language Pathology. Advisor: Katlyn McGrattan. 1 computer file (PDF); v, 23 pages.
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Dembroski, Greta. (2023). Validity of Clinical Indices of Feeding Performance at Detecting Swallow Study Results in Preterm Infants. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/256975.
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