Long-term outcomes in premature infants with chronic pulmonary aspiration

Aspiration is common in neonatal age, especially with a history of prematurity, and it can be silent until causing significant respiratory sequelae. The objective of this study is to evaluate the respiratory evolution of premature patients diagnosed with pulmonary aspiration during the first six months of life, using fiberoptic endoscopic evaluation of swallowing (FEES).

Retrospective study of premature infants in whom FEES was performed over a period of 12 years. They were classified into 2 groups: aspiration vs non-aspiration. Respiratory events were studied in a 3-year follow-up in both groups.

Sixty-two preterm infants younger than six months were included (39 with aspiration and 23 without aspiration). The mean gestational age was 28 weeks and the median age at FEES was 2.7 months. Approximately 60% of patients had associated comorbidities, with bronchopulmonary dysplasia being the most frequent. Thickened feeds were recommended in 82.1% of aspiration cases. During follow-up, hospital admissions due to respiratory causes occurred in 43.6% of the aspiration group and 52.2% of the non-aspiration group. The most common respiratory events were: upper respiratory tract infections (79.5%vs78.3%), bronchiolitis/bronchitis (76.9%vs69.6%), laryngitis (15.4%vs13%), brief resolved unexplained events (0% vs 13%), and pneumonia (30.8%vs26.1%). Although pneumonia appeared slightly earlier among infants with aspiration, no statistically significant differences were observed.

Over a three-year follow-up period, preterm infants diagnosed with aspiration and receiving appropriate treatment exhibited respiratory morbidity comparable to thouse without aspiration. Long-term follow-up with lung function and imaging tests of these patients would be necessary to determine their subsequent evolution.