Capturing infant swallow impairment on videofluoroscopy: timing matters

McGrattan, Katlyn; McGhee, Heather C.; McKelvey, Keeley L.; Clemmens, Clarice S.; Hill, Elizabeth G.; DeToma, Allan; Hill, Jeanne G.; Simmons, Cephus E.; Martin‐Harris, Bonnie

doi:10.1007/s00247-019-04527-w

Cited by 21 publications

(11 citation statements)

References 23 publications

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“…Results from the current study showed that burst number should be considered when assessing infant NNS. This notion is consistent with nutritive suck data that showed differences exist between judgments of swallowing physiology and the timing of fluoroscopic evaluation [29]. Furthermore, the authors state that if the fluoroscopic visualization is confined to the initial swallows of the bottle-feed, this likely limits the exam's diagnostic validity.…”

Section: Discussionsupporting

confidence: 76%

Changes in infant non-nutritive sucking throughout a suck sample at 3-months of age

2020

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The goal of this study was to compare how infants' non-nutritive suck (NNS) changes throughout a suck sample. Fifty-four full-term infants (57% male) completed this study at, on average, 3.03 (SD .31) months of age. These infants sucked on our custom research pacifier for approximately five minutes. Infants produced, on average, 14.50 suck bursts during the sample. NNS data was pooled across subjects and breakpoint analyses were completed to determine if there were changes in their NNS patterning. Breakpoints were evident for NNS cycles per burst at burst numbers 18 and 34, and for amplitude (cmH 2 0) at burst numbers 18 and 29. No breakpoints were present for NNS frequency. Infants exhibit changes in their suck physiology across burst number. When assessing suck, developmental specialists should observe more than one suck burst to attain a more valid and appropriate scope of the infant's suck ability.

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Section: Discussionsupporting

confidence: 76%

Changes in infant non-nutritive sucking throughout a suck sample at 3-months of age

2020

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“…It is notable that this is not the case for measures of gross systemic function, such as the Hammersmith Infant Neurological Examination, the Bayley Scales of Infant and Toddler Development Gross Motor subtest, and the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders, which have been regularly implemented across SMA trials and other investigations ( de Vivo et al, 2019 ; Finkel et al, 2016 , 2017 ; Mendell et al, 2017 ). With the recent establishment of valid and reliable dysphagia metrics ( Martin-Harris et al, 2018 ; K. E. McGrattan et al, 2020 ; Serel Arslan et al, 2018 ), the key step in integrating these metrics into the clinical and scientific arena is the involvement of the speech-language pathologist on the interdisciplinary neuromuscular clinical care and research teams.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia Phenotypes in Spinal Muscular Atrophy: The Past, Present, and Promise for the Future

McGrattan

Graham

DiDonato

et al. 2021

Am J Speech Lang Pathol

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Purpose The aim of this study was to provide clinicians with an overview of literature relating to dysphagia in spinal muscular atrophy (SMA) to guide assessment and treatment. Method In this clinical focus article, we review literature published in Scopus and PubMed between 1990 and 2020 pertaining to dysphagia in SMA across the life span. Original research articles that were published in English were included. Searches were conducted within four themes of inquiry: (a) etiology and phenotypes, (b) respiratory systemic deficits and management, (c) characteristics of natural history dysphagia and its treatment, and (d) dysphagia outcomes with disease-modifying therapies. Articles for the first two themes were selected by content experts who identified the most salient articles that would provide clinicians foundational background knowledge about SMA. Articles for the third theme were identified using search terms, including spinal muscular atrophy, swallow, dysphagia, bulbar, nutrition, g-tube, alternative nutrition, jaw, mouth, palate, OR mandible . Search terms for the fourth theme included spinal muscular atrophy AND nusinersen OR AVXS-101/onasemnogene abeparvovec-xioi . Review of Pertinent Literature Twenty-nine articles were identified. Findings across identified articles support the fact that patients with SMA who do not receive disease-modifying therapy exhibit clinically significant deficits in oropharyngeal swallow function. Few investigations provided systematic information regarding the underlying physiological deficits responsible for this loss in function, the timing of the degradation, or how disease-modifying therapies change these outcomes. Conclusion Future research outlining the physiological and functional oropharyngeal swallowing deficits among patients with SMA who receive disease-modifying therapy is critical in developing standards of dysphagia care to guide clinicians.

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“…Establishment of safe feeding is required prior to discharge 3 , 4 . In infants with feeding difficulties or frequent symptoms, it is common practice to assess the infants’ eating skills via dynamic x-ray imaging or videofluoroscopy swallowing study (VFSS) to provide structural and functional insight 5 , 6 . If penetration or aspiration is observed during the VFSS, feeding modifications are trialed and typically include nipple flow rate or fluid thickness changes further increasing the infant’s radiation exposure and associated risks 7 – 9 .…”

Section: Introductionmentioning

confidence: 99%

Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study

Jadcherla

Hasenstab

Osborn

et al. 2021

Sci Rep

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Videofluoroscopy swallow studies (VFSS) and high-resolution manometry (HRM) methods complement to ascertain mechanisms of infant feeding difficulties. We hypothesized that: (a) an integrated approach (study: parent-preferred feeding therapy based on VFSS and HRM) is superior to the standard-of-care (control: provider-prescribed feeding therapy based on VFSS), and (b) motility characteristics are distinct in infants with penetration or aspiration defined as penetration-aspiration scale (PAS) score ≥ 2. Feeding therapies were nipple flow, fluid thickness, or no modification. Clinical outcomes were oral-feeding success (primary), length of hospital stay and growth velocity. Basal and adaptive HRM motility characteristics were analyzed for study infants. Oral feeding success was 85% [76–94%] in study (N = 60) vs. 63% [50–77%] in control (N = 49), p = 0.008. Hospital-stay and growth velocity did not differ between approaches or PAS ≥ 2 (all P > 0.05). In study infants with PAS ≥ 2, motility metrics differed for increased deglutition apnea during interphase (p = 0.02), symptoms with pharyngeal stimulation (p = 0.02) and decreased distal esophageal contractility (p = 0.004) with barium. In conclusion, an integrated approach with parent-preferred therapy based on mechanistic understanding of VFSS and HRM metrics improves oral feeding outcomes despite the evidence of penetration or aspiration. Implementation of new knowledge of physiology of swallowing and airway protection may be contributory to our findings.

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Capturing infant swallow impairment on videofluoroscopy: timing matters

Cited by 21 publications

References 23 publications

Changes in infant non-nutritive sucking throughout a suck sample at 3-months of age

Changes in infant non-nutritive sucking throughout a suck sample at 3-months of age

Dysphagia Phenotypes in Spinal Muscular Atrophy: The Past, Present, and Promise for the Future

Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study

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