Epidemiology of swallow dysfunction in CDH patients

Area of Science:

• Pediatric Surgery
• Pulmonology
• Gastroenterology

Background:

• Congenital diaphragmatic hernia (CDH) is associated with significant long-term pulmonary complications.
• Delayed oral feeding skills and chronic aspiration are common in pediatric CDH patients.
• Aspiration can exacerbate lung injury in children with compromised pulmonary parenchyma due to CDH.

Purpose of the Study:

• To describe patterns of swallowing dysfunction and aspiration in pediatric patients with CDH.
• To determine the frequency of aspiration identified via video-fluoroscopic swallow study (VFSS) in CDH patients.
• To evaluate the impact of VFSS findings on patient management and explore associations with CDH severity.

Main Methods:

• Retrospective review of pediatric CDH patients treated between January 2014 and December 2019.
• Identification of patients undergoing VFSS for swallowing dysfunction concerns.
• Analysis of VFSS results for aspiration frequency, management changes, and correlation with CDH characteristics (side, defect size, need for patch).

Main Results:

• Out of 69 CDH patients, 35 underwent VFSS (10 inpatient, 25 outpatient).
• Aspiration was detected in 80% of inpatient and 68% of outpatient VFSS.
• VFSS findings led to management changes in 80% of cases, primarily involving oral feeding modifications.
• No significant association was found between CDH severity (side, defect size, patch use) and the need for VFSS or aspiration detection.

Conclusions:

• Aspiration is highly prevalent in the pediatric CDH population.
• VFSS is instrumental in identifying aspiration, guiding therapeutic interventions to protect lung health.
• The severity of the diaphragmatic defect does not predict the likelihood of aspiration on VFSS in these patients.