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Breastfeeding in infants who aspirate may increase risk of pulmonary inflammation
Daniel R Duncan1, Clare Golden1, Kara Larson1
1Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Breastfed infants with oropharyngeal dysphagia who continued breastfeeding faced higher risks of lung inflammation and hospitalizations. Management strategies impact pulmonary outcomes in these vulnerable infants.
Area of Science:
- Pediatrics
- Gastroenterology
- Pulmonology
Background:
- Oropharyngeal dysphagia is a condition affecting swallowing in infants.
- Breastfeeding is crucial for infant nutrition but can be complicated by dysphagia.
- Management strategies for dysphagia in breastfed infants require careful consideration of pulmonary risks.
Purpose of the Study:
- To evaluate the impact of different management strategies on pulmonary outcomes in breastfed infants diagnosed with oropharyngeal dysphagia.
- To assess the relationship between videofluoroscopic swallow study (VFSS) recommendations and subsequent respiratory health.
Main Methods:
- A retrospective cohort study was conducted on 76 breastfed infants with oropharyngeal dysphagia.
- Infants underwent VFSS to assess aspiration or laryngeal penetration.
- Medical records were reviewed for VFSS results, recommendations, chest X-rays, bronchoalveolar lavage (BAL) findings, and hospitalizations.
Main Results:
- 50% of infants had aspiration, and 50% had laryngeal penetration.
- 70% were cleared to continue breastfeeding, while 30% were not.
- Infants cleared to breastfeed experienced more pulmonary hospitalizations and signs of BAL inflammation (elevated neutrophils, positive cultures).
Conclusions:
- Continuing breastfeeding in infants with oropharyngeal dysphagia, despite recommendations, is associated with increased risk of BAL inflammation and pulmonary hospitalizations.
- Management decisions regarding breastfeeding cessation or continuation significantly influence respiratory health outcomes in these infants.
Objective:
To evaluate management strategies and pulmonary outcomes for breastfed infants with oropharyngeal dysphagia.
Study Design:
We performed a retrospective cohort study of breastfed infants diagnosed with oropharyngeal dysphagia with documented aspiration or laryngeal penetration on videofluoroscopic swallow study (VFSS). Medical records were reviewed for VFSS results and speech-language pathologist recommendations following VFSS, results of chest x-ray, results of bronchoalveolar lavage (BAL) within 1 year of VFSS, and aspiration-related hospitalizations occurring before or within 1 year of VFSS. Subjects were categorized as cleared or not cleared to breastfeed based on the VFSS. Proportions were compared with Chi-square and Fisher's exact tests and means with Student's t-tests.
Results:
Seventy-six infants (4.7 ± 0.4 months old) were included; 50% (38) had aspiration and 50% (38) had laryngeal penetration. After VFSS, 70% (53) were cleared to breastfeed while 30% (23) were not cleared to breastfeed. Patients with aspiration were less likely to be cleared to breastfeed (p = .006); however, 55% (21/38) of those with aspiration were still cleared to breastfeed. Infants cleared to breastfeed had significantly more pulmonary hospitalizations (p = .04) and were also at increased risk of elevated neutrophil count (p = .02) and culture growth on BAL (p = .01). Significantly increased abnormal neutrophil count was also found in those cleared to breastfeed with laryngeal penetration (p = .01).
Conclusions:
Infants with oropharyngeal dysphagia counseled to continue breastfeeding had increased risk of BAL inflammation and more pulmonary hospitalizations compared to those that were told to stop breastfeeding.
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