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Development of Swallowing Function in Infants with Oral Feeding Difficulties
Changhun Han1, Jaeho Shin2, Ga Won Jeon1,3
1Department of Pediatrics, Inje University Busan Paik Hospital, Busan, Republic of Korea.
Insights
Preterm infants, especially those born before 29 weeks, often have swallowing dysfunction. Interventions like swallow therapy and thickened formula aid recovery and prevent aspiration.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Speech-Language Pathology
Background:
- Oral feeding difficulties frequently delay discharge for preterm infants.
- Independent oral feeding is a critical milestone following management of neonatal morbidities.
- Swallowing dysfunction poses risks including aspiration and chronic lung injury.
Purpose of the Study:
- To determine the prevalence and characteristics of swallowing dysfunction in preterm infants.
- To identify risk factors associated with swallowing dysfunction.
- To suggest interventions for reducing aspiration and chronic lung injury.
Main Methods:
- Retrospective analysis of 54 infants undergoing modified barium swallow study (MBSS) for oral feeding difficulties.
- MBSS performed at or after 37 postmenstrual weeks to minimize radiation exposure.
- Swallowing dysfunction defined by inadequate epiglottic closure, laryngeal penetration, or tracheal aspiration.
Main Results:
- Infants with swallowing dysfunction had lower gestational age and birth weight.
- Longer mechanical and invasive ventilation durations were associated with swallowing dysfunction.
- Gestational age < 29 weeks increased swallowing dysfunction risk 11.2-fold; most infants improved with maturation and therapy.
Conclusions:
- Preterm infants born before 29 weeks or with prolonged ventilation are at higher risk for aspiration.
- Swallow therapy and thickened formula are effective interventions.
- These interventions help prevent aspiration, chronic lung injury, and support parental reassurance.
Background:
Discharge of preterm infants is often delayed because of their oral feeding difficulties. Independent oral feeding is the last obstacle to pass after managing acute and chronic morbidities. We conducted this study to determine the prevalence, characteristics, and risk factors of swallowing dysfunction and suggest proper interventions to reduce aspiration and chronic lung injury.
Methods:
Infants admitted to the neonatal intensive care unit (January 2016 to December 2018) who were performed modified barium swallow study due to oral feeding difficulties were enrolled. Modified barium swallow study was done ≥ postmenstrual age 37 weeks to limit radiation exposure. Clinical data were collected retrospectively. Swallowing dysfunction was defined as inadequate epiglottic closure, laryngeal penetration, or tracheal aspiration according to result of the modified barium swallow study.
Results:
Among a total of 54 infants enrolled, nine (16.7%) were term infants, 13 (24.1%) were late preterm infants (gestational age, 34-36 weeks), and 32 (59.3%) were early preterm infants (gestational age < 34 weeks). Gestational age and birth weight were smaller in infants with swallowing dysfunction. Total duration of mechanical ventilation and duration of invasive ventilation were longer in infants with swallowing dysfunction. The risk of swallowing dysfunction increased by 11.2 times for infants with gestational age < 29 weeks compared to infants with gestational age ≥ 29 weeks. Swallowing dysfunction was improved in most infants after they became matured. They showed different time and rate of maturation with the help of rehabilitation through swallow therapy and dietary modification with thickened formula.
Conclusion:
Preterm infants with gestational age < 29 weeks or with longer ventilation duration are at a higher risk of aspiration. Rehabilitation of swallow therapy and dietary modification with thickened formula can be helpful interventions to prevent aspiration and chronic lung injury and reassure parents until independent oral feeding is possible.
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