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Assessing Swallowing of the Breastfeeding NICU Infant Using Fiberoptic Endoscopic Evaluation of Swallowing: A
Erika S Armstrong1, Jenny Reynolds, Chrysty Sturdivant
1Communication Sciences and Oral Health, Texas Woman's University, Denton, Texas (Dr Armstrong); and Physical Medicine (Mss Reynolds, Sturdivant, and Carroll) and Neonatology (Dr Suterwala), Baylor University Medical Center, Dallas, Texas.
Insights
Fiberoptic endoscopic evaluation of swallowing (FEES) during breastfeeding (FEES-B) is safe for premature infants in the NICU. While feasibility data is limited, this pilot study shows promise for assessing infant feeding difficulties.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Speech-Language Pathology
Background:
- Premature infants often experience feeding difficulties, necessitating instrumental swallowing assessments.
- Fiberoptic endoscopic evaluation of swallowing (FEES) is a valuable tool for assessing both bottle and breastfeeding in infants.
Purpose of the Study:
- To investigate the safety and feasibility of performing FEES during breastfeeding (FEES-B) in infants within a Neonatal Intensive Care Unit (NICU).
Main Methods:
- A prospective, descriptive pilot study was conducted in a level III NICU.
- Five premature infants (≥37 weeks postmenstrual age) with feeding difficulties underwent FEES-B.
- Safety was assessed by monitoring adverse events and vital signs; feasibility was evaluated by visualizing milk, laryngeal penetration, and tracheal aspiration.
Main Results:
- No adverse events (e.g., epistaxis, laryngospasm) or autonomic instability were observed.
- No significant changes in respiratory rate, heart rate, or oxygen saturation occurred.
- Two infants successfully breastfed during FEES-B, with milk visualized in the pharynx; one infant showed laryngeal penetration.
Conclusions:
- FEES-B appears to be a safe procedure for NICU infants, with no observed physiologic instability.
- Limited data suggests potential feasibility, with milk visualization during breastfeeding.
- Further research is needed to establish the effectiveness of FEES-B for infant feeding assessments.
Background:
Premature infants may demonstrate feeding difficulties requiring an instrumental swallowing assessment. Fiberoptic endoscopic evaluation of swallowing (FEES) is one assessment that can evaluate bottle feeding and breastfeeding.
Purpose:
This pilot study investigated the safety and feasibility of FEES for neonatal intensive care unit (NICU) infants during breastfeeding.
Methods:
The setting for this prospective, descriptive study was an urban level III NICU that provided care for premature and critically ill infants. Participants were 5 infants recruited from a convenience sample who were at least 37 weeks postmenstrual age, demonstrated feeding difficulties during a bedside feeding and swallowing examination, and were breastfeeding. Each participant received a FEES assessment while breastfeeding (FEES-B). Adverse events and vital signs including prefeeding and postfeeding respiratory rate, heart rate, and oxygen saturation level were recorded to assess safety. Visualization of milk, laryngeal penetration, and tracheal aspiration assessed feasibility.
Results:
Participants had a mean postmenstrual age of 39.8 weeks. No adverse events, including epistaxis or laryngospasm, were reported; there were no instances of autonomic instability; and there were no statistically significant differences between prefeeding and postfeeding respiratory rate, heart rate, or oxygen saturation level. Two infants successfully breastfed during FEES-B. Human milk was observable, and laryngeal penetration was noted with 1 infant.
Implication For Practice:
FEES-B was found to be safe, with limited data supporting feasibility. Infants demonstrated no physiologic instability during FEES-B, and milk was visualized in the pharynx during breastfeeding with 2 infants.
Implication For Research:
Further studies are warranted to assess effectiveness of FEES-B in infants.
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