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Identifying Aspiration Among Infants in Neonatal Intensive Care Units Through Occupational Therapy Feeding
O Jayne Bowman1, Joseph L Hagan2, Rose Marie Toruno3
1O. Jayne Bowman, OT, PhD, is Associate Professor, School of Occupational Therapy, Texas Woman's University, Houston; occupationaltherapyworks@outlook.com.
Insights
Occupational therapists can better identify infants at risk for aspiration by observing feeding over multiple sessions, as symptoms may not always align with videofluoroscopic swallowing study (VFSS) findings.
Area of Science:
- Neonatal care
- Pediatric occupational therapy
- Swallowing disorders
Background:
- Oropharyngeal aspiration in neonates can lead to severe health issues, including developmental delays and mortality.
- Occupational therapists in Neonatal Intensive Care Units (NICUs) play a crucial role in identifying at-risk infants for aspiration.
Purpose of the Study:
- To determine if occupational therapy feeding evaluation findings correlate with videofluoroscopic swallowing study (VFSS) results in infants aged 0-6 months.
- To enhance the identification of neonates at risk for aspiration.
Main Methods:
- Retrospective chart review of 334 infants (0-6 months) admitted to a NICU.
- Analysis of feeding evaluations by occupational therapists and VFSS by speech-language pathologists.
- Assessment of client factors and performance skills during feeding evaluations.
Main Results:
- Occupational therapy evaluation findings, including signs and symptoms of aspiration, were significantly associated with VFSS results.
- A significant percentage of infants (55%) aspirated on VFSS without showing symptoms during the feeding evaluation.
- Silent aspiration was identified in 79 out of 310 patients.
Conclusions:
- Infant aspiration is inconsistent and influenced by individual factors, contexts, and environments.
- Occupational therapists should conduct multiple feeding assessments to accurately gauge an infant's feeding status.
- This study aids occupational therapists in identifying aspiration risks and optimizing feeding recommendations.
Importance:
When a neonate's sucking, swallowing, and breathing are disorganized, oropharyngeal aspiration often occurs and results in illness, developmental problems, and even death. Occupational therapists who work in the neonatal intensive care unit (NICU) need to identify neonates who are at risk for aspirating so they can provide appropriate treatment.
Objective:
To ascertain whether client factors and performance skills of infants ages 0-6 mo during occupational therapy feeding evaluations are related to results of videofluoroscopic swallowing studies (VFSSs).
Design:
Retrospective chart reviews.
Setting:
187-bed NICU in a nonprofit teaching hospital.
Participants:
A purposive sample of 334 infants ages 0-6 mo, ≥33 wk gestational age at birth, admitted to a Level II, III, or IV NICU as defined by the American Academy of Pediatrics.
Outcomes And Measures:
Neonates were administered a feeding evaluation by an occupational therapist and a VFSS by a speech-language pathologist, which yielded information about client factors and performance skills.
Results:
Signs and symptoms of aspiration on the evaluations were significantly associated with VFSS results. Of 310 patients, 79 had silent aspiration. Of 55 infants who demonstrated no aspiration symptoms during the feeding evaluation, 45% demonstrated aspiration symptoms on the VFSS, and 55% aspirated on the VFSS but demonstrated no symptoms of aspiration.
Conclusions And Relevance:
Aspiration among infants occurs inconsistently and depends on client factors, contexts, and environments. Occupational therapists are encouraged to assess an infant's feeding over several sessions to obtain a more accurate picture of the infant's feeding status.
What This Article Adds:
This study provides information that helps occupational therapists identify infants at risk for aspiration and make optimal recommendations regarding safe feeding practices and appropriate referrals for a VFSS. Making appropriate referrals for VFSS is also important in preventing unnecessary exposure to radiation for preterm infants.
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