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Isolated neonatal swallowing dysfunction: a case series and review of the literature
Robert B Heuschkel1, Kara Fletcher, Arden Hill
1Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts 02115, USA.
Insights
Isolated neonatal swallowing dysfunction (INSD) typically presents in newborns with feeding difficulties. Despite requiring prolonged nutritional support, most infants with INSD experience a good long-term prognosis.
Area of Science:
- Pediatrics
- Neonatology
- Gastroenterology
Background:
- Neonatal swallowing dysfunction can significantly impact infant feeding and growth.
- Understanding the natural history of isolated neonatal swallowing dysfunction (INSD) is crucial for appropriate management.
Purpose of the Study:
- To describe the natural history and clinical course of infants diagnosed with isolated neonatal swallowing dysfunction (INSD).
Main Methods:
- Retrospective case series describing nine infants with INSD.
- Detailed review of symptoms, feeding methods, neurological findings, and long-term outcomes.
Main Results:
- Eight infants presented within two weeks of birth with symptoms including choking, aspiration, apnea, and vomiting.
- Three infants had nonspecific neurological abnormalities, later diagnosed with underlying genetic disorders.
- All infants required tube feeding; six tolerated nasogastric (NG) feeding and received a gastrostomy tube, while three required jejunal feedings.
- Gastrostomy tubes were removed in 7/9 infants at a mean age of 37 months.
- INSD demonstrated a good long-term prognosis, with most infants improving over time.
Conclusions:
- Isolated neonatal swallowing dysfunction generally has a favorable long-term prognosis.
- The presence of neurological abnormalities may indicate an underlying disorder requiring further investigation.
- Nutritional support, including NG and gastrostomy tubes, is often necessary, with jejunal feeding required in some cases.
- Long-term nutritional support may be needed for up to three years or more.
Abstract:
Our purpose was to describe the natural history of isolated neonatal swallowing dysfunction (INSD). Nine infants with INSD are described. Eight presented within two weeks of birth. Symptoms included choking and cyanotic spells with feeds, recurrent aspiration, apnea, stridor, and vomiting. Three had nonspecific neurological abnormalities and were diagnosed later in life with underlying disorders (myotonic dystrophy, CHARGE association, velocardiofacial syndrome). All required tube feeding. Six tolerated nasogastric feedings and received a gastrostomy tube. Three failed nasogastric feeds and required jejunal feedings. The gastrostomy tube was removed in 7/9 at a mean age of 37 +/- 9 months. In conclusion, INSD has a good long-term prognosis. The presence of minor neurological abnormalities at presentation suggests another underlying disorder. Nasogastric feeding followed by a gastrostomy is recommended in those without gastroesophageal reflux. Jejunal feedings are necessary in some. While most improve over time, they may need nutritional support for 3 years or more.