Background. Discharge of preterm infants is often delayed because of their oral feeding difficulties. Independent oral feeding is the last obstacle to pass after managing acute and chronic morbidities. We conducted this study to determine the prevalence, characteristics, and risk factors of swallowing dysfunction and suggest proper interventions to reduce aspiration and chronic lung injury. Methods. Infants admitted to the neonatal intensive care unit (January 2016 to December 2018) who were performed modified barium swallow study due to oral feeding difficulties were enrolled. Modified barium swallow study was done≥postmenstrual age 37 weeks to limit radiation exposure. Clinical data were collected retrospectively. Swallowing dysfunction was defined as inadequate epiglottic closure, laryngeal penetration, or tracheal aspiration according to result of the modified barium swallow study. Results. Among a total of 54 infants enrolled, nine (16.7%) were term infants, 13 (24.1%) were late preterm infants (gestational age, 34-36 weeks), and 32 (59.3%) were early preterm infants (gestational age<34 weeks). Gestational age and birth weight were smaller in infants with swallowing dysfunction. Total duration of mechanical ventilation and duration of invasive ventilation were longer in infants with swallowing dysfunction. The risk of swallowing dysfunction increased by 11.2 times for infants with gestational age<29 weeks compared to infants with gestational age≥29 weeks. Swallowing dysfunction was improved in most infants after they became matured. They showed different time and rate of maturation with the help of rehabilitation through swallow therapy and dietary modification with thickened formula. Conclusion. Preterm infants with gestational age<29 weeks or with longer ventilation duration are at a higher risk of aspiration. Rehabilitation of swallow therapy and dietary modification with thickened formula can be helpful interventions to prevent aspiration and chronic lung injury and reassure parents until independent oral feeding is possible.
Purpose: Patent ductus arteriosus (PDA) is associated with increased mortality and morbidities such as intraventricular hemorrhage, necrotizing enterocolitis, bronch opulmonary dysplasia, and neurodevelopmental impairment. The objective of this study was to evaluate mortality and morbidities according to the time of PDA closure. Methods: For this study, 117 preterm infants with gestational age (GA) of <30 weeks who had PDA were enrolled and allocated to two groups according to the time of PDA closure as follows: early closed group (n=40, PDA closure in <14 days after birth) and delayed closed group (n=77, PDA closure in ≥14 days after birth). Results: GA was higher in the early closed group than in the delayed closed group (27.2±1.6 weeks vs. 26.3±1.7 weeks, P=0.005). Other demographic factors, such as birth weight, Apgar score, and maternal status were not significantly different between the two groups. The incidence rates of surfactant redosing, retinopathy of prematurity (stage ≥II), necrotizing enterocolitis (stage ≥II), moderate to severe bronchopulmo nary dysplasia, and mortality were similar between the two groups. The total durations of mechanical ventilation, invasive ventilation, and hospital stay were longer in the delayed closed group than in the early closed group. However, these became similar after adjustment for GA. The incidence rate of intraventricular hemorrhage (grade ≥III) was significantly higher in the early closed group than in the delayed closed group after adjustment for GA (25.0% vs. 13.0%, adjusted P for GA=0.021). Conclusion: In this study, delayed PDA closure was safe, as it did not increase mortality and morbidity rates.
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