Related Experiment Video
Updated: Jun 3, 2025
Adapting Human Videofluoroscopic Swallow Study Methods to Detect and Characterize Dysphagia in Murine Disease Models
Published on: March 1, 2015
Evaluation of Swallowing Dysfunction With Flexible Endoscopic Evaluation of Swallowing in the Neonatal Unit
Aaron Heston1, Anjali Patel2, Kevin Ahn2
1Division of Neonatology, Department of Child Health, Phoenix Children's Hospital, Phoenix Campus, The University of Arizona.
Insights
Flexible endoscopic evaluation of swallowing (FEES) effectively identifies feeding and swallowing abnormalities in preterm infants. FEES guided interventions improved oral feeding and reduced cardiorespiratory events in neonates.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Speech-Language Pathology
Background:
- Preterm and low-birth-weight infants often exhibit impaired suck-swallow-breathe coordination, leading to feeding difficulties and increased risk of aspiration.
- Videofluoroscopic swallowing study is standard, but flexible endoscopic evaluation of swallowing (FEES) is an emerging diagnostic tool for neonatal swallow function.
Purpose of the Study:
- To evaluate the utility of FEES in identifying functional and anatomical abnormalities, secretions, penetration/aspiration, and residue in neonatal intensive care unit (NICU) infants.
- To assess the impact of FEES on clinical feeding decisions and oral feeding progression.
Main Methods:
- A retrospective, single-center study of 90 NICU infants who underwent FEES between 2018-2023.
- Analysis of FEES findings including abnormalities, penetration/aspiration, residue, and anatomical variations.
- Review of changes in feeding recommendations and oral feeding progression post-FEES.
Main Results:
- 85.5% of infants showed abnormal FEES findings, with 37.7% aspirating and 34.5% exhibiting laryngeal penetration.
- 39% had anatomical abnormalities, including laryngomalacia (27.7%); 10 had unanticipated abnormalities requiring intervention in 4 cases.
- FEES guided interventions led to increased oral feeding (45% to 75%) and decreased apneic, bradycardic, and desaturation events.
Conclusions:
- FEES is highly effective in detecting swallow dysfunction, aspiration, and anatomical abnormalities in NICU infants.
- FEES-guided feeding modifications significantly improved oral feeding success and clinical outcomes.
- Early identification and intervention for anatomical abnormalities via FEES can lead to necessary surgical referrals and improved patient management.
Background:
Preterm and low-birth-weight infants often experience discoordination of the suck-swallow-breathe pattern, leading to dysrhythmic feeding, inefficient feeding skills, and swallowing dysfunction, increasing the risk of aspiration and respiratory morbidity. While videofluoroscopic swallowing study is commonly utilized to assess swallow function in neonates, flexible endoscopic evaluation of swallowing (FEES) has been an emerging modality and has been utilized routinely at our institution since 2018.
Method:
A single-center, retrospective study including 90 infants admitted to the neonatal unit between 2018-2023 who underwent FEES procedure. Our objective was to evaluate the utility of FEES for evaluating functional and anatomical abnormalities, secretions, penetration/aspiration, and residue in infants in the Neonatal Intensive Care Unit. Our secondary objective was to observe whether clinical feeding decisions were changed based on FEES and describe progress in oral feeding.
Results:
A majority of infants (85.5%) were reported to have abnormal FEES findings, with aspiration below the vocal cords noted in 37.7% and laryngeal penetration reported in 34.5% of the infants. Anatomical abnormalities were reported in 39% of infants including predominantly laryngomalacia (27.7%). Ten infants were noted to have unanticipated anatomical abnormalities, of which four went on to require surgical interventions. Changes in nipple or bottle were the most frequent recommendations (68.8%) with thickening of feeds recommended in 35% of infants. The percentage of oral feedings increased from median of 45% to 75% with a decrease in infants with apneic, bradycardic, and desaturation events in the 7 days after FEES guided interventions were introduced.
Conclusions:
Majority of the infants with clinical concerns of swallow dysfunction were noted to have abnormalities on FEES, with one third of infants reported to have aspiration and anatomical abnormalities. Changes in feeding practices were recommended to majority of the infants based on FEES evaluation. Four of the five infants with anatomical abnormalities referred urgently for specialist evaluation required interventions.
More Related Videos
Related Concept Videos
01:29Endoscopic Procedures I: Esophagogastroduodenoscopy
During an EGD, the endoscope can be used to:
01:24Upper GI Series: Barium Swallow
Purpose and Procedure
Patients undergoing this procedure ingest a liquid containing barium sulfate with a chalky...
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
01:28Endoscopic Procedures III: Video Capsule Endoscopy
01:26Assessment of the Mouth
Mouth Inspection
The inspection begins with visually examining the mouth for symmetry, color, and size.