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[Recurrent bronchopneumopathies in the infant due to swallowing dyspraxia. Two cases]
F Renault1, J Couvreur, C Ostre
1Laboratoire de Neurophysiologie Clinique de l'Enfant, Hôpital Armand-Trousseau, Paris.
Insights
Two infants with recurrent respiratory infections had swallowing and sucking disorders causing aspiration. Neurophysiologic studies confirmed central nervous system anomalies, which improved over time.
Area of Science:
- Pediatric Neurology
- Neurophysiology
- Swallowing Disorders
Background:
- Recurrent lower respiratory tract infections in infants can stem from various causes.
- Identifying the precise etiology is crucial for effective management and prognosis.
Observation:
- Two infants presented with recurrent lower respiratory tract infections from early infancy.
- Dynamic electromyographic studies revealed lingual and pharyngeal dysfunction during sucking and swallowing.
- Impaired blinking reflexes and brainstem auditory evoked potential anomalies suggested central neurofunctional deficits.
Findings:
- The observed swallowing and sucking disorder was directly linked to aspiration episodes.
- Absence of peripheral neuromuscular anomalies and normal MRI scans pointed to a central nervous system origin.
- Neurofunctional anomalies demonstrated improvement over extended follow-up periods (23 months and 4 years).
Implications:
- Neurophysiologic investigations are vital for diagnosing the neurological basis of infant swallowing disorders.
- These studies can localize the lesion within the central nervous system (medulla oblongata).
- Differentiating functional from organic neurological anomalies is key for targeted therapeutic strategies.
Abstract:
In two infants with recurrent lower respiratory tract infections starting within a few weeks of birth, dynamic electromyographic studies of sucking and swallowing evidenced a disorder of lingual and pharyngeal activities responsible for the episodes of aspiration. The central location of the anomaly was demonstrated by the absence of peripheral neuromuscular anomalies and by the presence of impaired blinking reflexes and brain stem potential anomalies. These neurofunctional anomalies improved over time and magnetic resonance imaging failed to disclose and structural anomalies of the central nervous system. The occurrence of the swallowing disorder as an isolated manifestation and its long duration, with follow-ups of 23 months and 4 years, are two unique features in these cases. Neurophysiologic investigations are essential for documenting the neurologic etiology of the swallowing disorders, demonstrating their location above or within the medulla oblongata, and differentiating functional and organic anomalies.