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Infant aspiration and associated signs on clinical feeding evaluation
Arcangela L Balest1, Amanda S Mahoney2, Amber D Shaffer3
1UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, Division of Neonatology, USA.
Insights
Clinical feeding evaluations can indicate aspiration in infants under 51 weeks post-menstrual age. Signs like cough and oxygen desaturations on CFE suggest aspiration risk, but further research is needed for predictive accuracy.
Area of Science:
- Pediatrics
- Neonatology
- Speech-Language Pathology
Background:
- Infants under 51 weeks post-menstrual age (PMA) have an underdeveloped laryngeal cough reflex, complicating aspiration assessment.
- Clinical feeding evaluations (CFE) are used to identify potential aspiration risks in this population.
- Modified barium swallow studies (MBS) provide objective data on aspiration but are resource-intensive.
Purpose of the Study:
- To investigate the association between clinical signs on CFE and comorbid conditions with aspiration (silent or overt) in infants <51 weeks PMA.
- To determine if lower respiratory infection (LRI) is linked to aspiration in this age group.
- To evaluate the sensitivity and specificity of CFE findings for detecting aspiration and the role of speech-language pathologist (SLP) experience.
Main Methods:
- Retrospective chart review of infants (<51 weeks PMA) who underwent MBS and CFE within seven days of each other.
- Logistic regression analysis to assess the impact of CFE findings, age, comorbidities, and aerodigestive diagnoses on aspiration.
- Calculation of sensitivity and specificity of CFE for identifying silent aspiration (SA).
Main Results:
- 40% of infants had silent aspiration (SA) and 8% had overt aspiration on MBS.
- Clinical signs on CFE, including cough, oxygen desaturations, and chest congestion, were associated with increased odds of SA.
- Cough on CFE predicted overt aspiration; LRI was not significantly associated with aspiration. CFE sensitivity for SA was 98%, specificity 15%.
Conclusions:
- Clinical signs observed during feeding evaluations in young infants may indicate a higher risk of aspiration.
- While CFE shows high sensitivity for detecting potential aspiration, its low specificity suggests a need for further investigation.
- More research is needed to establish specific CFE signs as reliable predictors of aspiration in infants <51 weeks PMA.
Objectives:
Few studies have examined clinical signs of aspiration in infants <51 weeks post-menstrual age (PMA) for whom the laryngeal cough reflex is not fully developed. This retrospective study explored 1) the association between signs of aspiration on a clinical feeding evaluation (CFE) and/or comorbid conditions with aspiration (silent or overt) on a modified barium swallow study (MBS) for infants in this age range, 2) the association between lower respiratory infection (LRI) and aspiration on MBS, and 3) the sensitivity and specificity of detecting aspiration according to signs on CFE and the evaluating speech-language pathologist's (SLP) years of experience.
Methods:
A retrospective review of charts of patients with MBS completed January 1, 2012-December 31, 2014 was performed. Patients were included if they were <51-weeks PMA at the time of MBS and had a CFE conducted no more than seven days prior to the MBS. Patient age, comorbidities, and MBS and CFE details were collected. The impact of CFE findings, patient age, comorbid syndromes/associations, and aerodigestive diagnoses on the odds of demonstrating silent aspiration (SA) or overt aspiration during MBS with thin liquids was determined using logistic regression, and the sensitivity and specificity of CFE for identifying SA was calculated.
Results:
Results from 114 patients indicated that 46 (40 %) of the infants had SA and nine (8 %) had overt aspiration on MBS. Notable signs on CFEs were cough (36 %), oxygen desaturations (33 %), and chest congestion (32 %). On multiple regression analysis there was increased odds of SA on MBS with at least one clinical sign on CFE (OR: 24.3, p = 0.02), chronic lung disease, (OR: 18.2, p = 0.01), and airway abnormalities (OR: 2.94, p = 0.01). Cough on CFE was associated with increased odds of overt aspiration on MBS (OR: 5.69, p = 0.04). Neither SA nor overt aspiration were significantly associated with LRI. Sensitivity and specificity of CFE for correctly identifying the presence of SA were 98 % and 15 %, respectively; experience of the SLP was not a contributing factor.
Conclusion:
Further study is required to determine if specific signs on CFE are predictive of aspiration.
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