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The use of pulse oximetry as a screening assessment for paediatric neurogenic dysphagia
A T Morgan1, R Omahoney, H Francis
1Developmental Cognitive Neuroscience Unit, UCL, Institute of Child Health, UK. angela.morgan@mcri.edu.au
Insights
Pulse oximetry shows potential for objectively screening pediatric dysphagia. Measuring oxygen saturation (SpO2) during feeding can help identify children with swallowing difficulties, complementing existing subjective methods.
Area of Science:
- Pediatric Medicine
- Clinical Diagnostics
- Respiratory Physiology
Background:
- Early detection of pediatric dysphagia is vital to prevent malnutrition and respiratory issues.
- Current screening methods for pediatric dysphagia lack sensitivity and specificity.
- Objective diagnostic tools are needed to improve dysphagia assessment in children.
Purpose of the Study:
- To evaluate pulse oximetry as an objective tool for screening pediatric dysphagia.
- To determine if oxygen saturation (SpO2) levels can differentiate children with and without dysphagia.
- To analyze SpO2 variations (pre-, during, post-feeding) and desaturation events in relation to dysphagia.
Main Methods:
- A case-control study involving 9 children with chronic neurological disability (dysphagia) and 9 matched controls.
- Participants underwent clinical bedside evaluation (CBE) and continuous pulse oximetry during feeding.
- Assessment included average SpO2 levels and desaturation events before, during, and after oral feeding.
Main Results:
- A statistically significant difference in SpO2 levels was observed between groups during oral feeding (p < 0.001).
- Pulse oximetry demonstrated 88.9% sensitivity and 88.9% specificity in differentiating dysphagia.
- Only three children with dysphagia experienced SpO2 desaturation events during feeding.
Conclusions:
- Pulse oximetry, specifically average SpO2 during feeding, may serve as a valuable adjunct to CBE for pediatric dysphagia screening.
- Objective SpO2 measurements offer moderate predictive accuracy for identifying dysphagia.
- Further research on larger, homogenous populations is needed to establish definitive criteria for SpO2-related pathological findings in pediatric dysphagia.
Purpose:
Early screening and intervention for dysphagia is crucial to offset potential outcomes such as compromised nutrition or reduced respiratory function. Current paediatric dysphagia screening tests are subjective with poor sensitivity and specificity. The present study examined whether an objective method, pulse oximetry (measuring oxygen saturation (SpO2) levels), could differentiate between children with and without dysphagia, in relation to (1) Average pre-feeding baseline SpO2 levels; (2) Average feeding SpO2 levels; (3) Average post-feeding SpO2 levels; and (4) The number of events of oxygen desaturation pre-, during and after feeding.
Methods:
Nine participants with chronic neurological disability (CND) (7 F, 2 M) (9; 7-15; 11 years) and nine control participants matched for age (9; 5-16; 0 years) and sex were assessed using a clinical bedside evaluation (CBE) and pulse oximetry.
Results:
A statistically significant difference was found in SpO2 levels between the two groups (p < 0.001) during oral feeding only (sensitivity, 88.9%; specificity, 88.9%). Only three children with dysphagia experienced 'events' of SpO2 desaturation during feeding.
Conclusion:
Pulse oximetry may provide a useful adjunct to the CBE for dysphagia screening, with average SpO2 levels during feeding predicting those with and without dysphagia with moderate levels of sensitivity and specificity. The finding of individual variation in desaturation 'events', however, warrants the provision of further data on large homogenous populations to provide definitive criterion for pathological SpO2 levels associated with dysphagia during oral feeding.
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