A Retrospective Cohort Study to Evaluate a Swallow Study Use in the NICU Population to Optimize Feeding Support

Premature neonates demonstrate difficulties with swallowing due to neurological immaturity as well as a weaker suck reflex compared to full term infants. Swallowing starts to mature by 33-34 weeks of gestational age. In neonates, dysphagia is evaluated clinically by speech-language pathologists and a swallow study is ordered for infants with swallowing difficulties. However, leaving the NICU to undergo a swallow study puts infants under environmental stressors and a swallow study exposes infants to radiation. There is a concern that swallow studies are being over-utilized in the NICU.

All premature infants born before 36 weeks GA admitted to the Sanford Boekelheide NICU between January 2015 and December 2019 who underwent a swallow study were enrolled in data analysis. Deidentified data was collected retrospectively through electronic medical record review and RedCap was utilized for data storage. Infants were divided in two cohorts; those who underwent a feeding change (feeding thickening) following a swallow study vs those who continued with prior feedings. Infant demographics and characteristics were assessed to identify a group of infants who are at high risk of aspiration.

A total of 179 infants were identified.

A swallow study can identify infants at high risk for aspiration, however, many could potentially be avoided by allowing more time for infant maturation.