Assessing Swallowing of the Breastfeeding NICU Infant Using Fiberoptic Endoscopic Evaluation of Swallowing

Abstract

Background: Premature infants may demonstrate feeding difficulties requiring an instrumental swallowing assessment. Fiberoptic endoscopic evaluation of swallowing (FEES) is one assessment that can evaluate bottle feeding and breastfeeding. Purpose: This pilot study investigated the safety and feasibility of FEES for neonatal intensive care unit (NICU) infants during breastfeeding. Methods: The setting for this prospective, descriptive study was an urban level III NICU that provided care for premature and critically ill infants. Participants were 5 infants recruited from a convenience sample who were at least 37 weeks postmenstrual age, demonstrated feeding difficulties during a bedside feeding and swallowing examination, and were breastfeeding. Each participant received a FEES assessment while breastfeeding (FEES-B). Adverse events and vital signs including prefeeding and postfeeding respiratory rate, heart rate, and oxygen saturation level were recorded to assess safety. Visualization of milk, laryngeal penetration, and tracheal aspiration assessed feasibility. Results: Participants had a mean postmenstrual age of 39.8 weeks. No adverse events, including epistaxis or laryngospasm, were reported; there were no instances of autonomic instability; and there were no statistically significant differences between prefeeding and postfeeding respiratory rate, heart rate, or oxygen saturation level. Two infants successfully breastfed during FEES-B. Human milk was observable, and laryngeal penetration was noted with 1 infant. Implication for Practice: FEES-B was found to be safe, with limited data supporting feasibility. Infants demonstrated no physiologic instability during FEES-B, and milk was visualized in the pharynx during breastfeeding with 2 infants. Implication for Research: Further studies are warranted to assess effectiveness of FEES-B in infants.

Implementation of Pediatric Flexible-Endoscopic Evaluation of Swallowing: A Systematic Review and Recommendations for Future Research

“…Nine studies exclusively focused on infants under 1 year of age [ 12 – 20 ]; five samples consisted of children younger than 12 months up to 3 years [ 21 – 25 ]; one study focused on children between 4 and 8 years [ 26 ], and a wide age distribution including infants, children and adolescents could be found in seven studies [ 10 , 11 , 27 – 30 ] (Table 4 ).…”

“…Further analysis of the samples showed that three studies included only infants from the neonatal intensive care unit (NICU) [ 12 , 14 , 18 ], one focused on mechanically ventilated children [ 23 ], and two had a surgical focus [ 13 , 25 ]. Six studies related to a single diagnosis or symptom: Congenital Zika Syndrome [ 22 ], isolated Pierre-Robin sequence [ 15 ], laryngomalacia [ 16 ] and gastroesophageal reflux disease (GERD) [ 17 ], cerebral palsy [ 26 ], and prematurity [ 19 ].…”

Position Statement of the Union of European Phoniatricians (UEP): Fees and Phoniatricians’ Role in Multidisciplinary and Multiprofessional Dysphagia Management Team

“…Early detection and management have a significant effect on development, health, and psychosocial aspects. So far, no standard protocol for paediatric FEES has been established [ 45 – 49 ].…”

“…Early detection and management have a significant effect on development, health, and psychosocial aspects. So far, no standard protocol for paediatric FEES has been established [45][46][47][48][49]. -Patients with ICU-related dysphagia may suffer from laryngotracheal complications after long-term intubation and tracheostomy.…”

Flexible Endoscopic Evaluation of Swallowing in Breastfeeding Infants With Laryngomalacia: Observed Clinical and Endoscopic Changes With Alteration of Infant Positioning at the Breast

“…[16][17][18][19] FEES has also proven to be an appropriate and safe modality for assessing the breastfeeding swallow and is able to provide a dynamic three-dimensional view of pharyngeal and laryngeal anatomy that can be helpful in the diagnosis of both airway and swallowing pathology. [19][20][21][22] However, as FEES lacks objective measures that are readily available with VFSS, the understanding of the pharyngeal phase of the infant swallow remains predominantly based on research using VFSS viewing bottle feeding.…”