Presenting Signs and Symptoms do not Predict Aspiration Risk in Children

Duncan, Daniel R.; Mitchell, Paul D.; Larson, Kara; Rosen, Rachel

doi:10.1016/j.jpeds.2018.05.030

Cited by 52 publications

(34 citation statements)

References 39 publications

(52 reference statements)

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“…Our study is one of few that describes clinical outcomes following VFSS guided feeding interventions. (3,4,(7)(8)(9) Although there may be some spontaneous improvement, the signi cant decrease in hospitalizations and requirement for antibiotics following feeding interventions in this cohort is noteworthy.…”

Section: Discussionmentioning

confidence: 78%

“…Although VFSS is resource intensive and involves radiation, it remains essential particularly in cases with higher morbidity or where silent aspiration (SA) without a corresponding protective cough re ex, is suspected. (5,6) Recent studies suggest that CFE may not adequately predict aspiration risk in children, (7) compared with VFSS. (8) The present study aimed to determine the reliability of the CFE compared with VFSS in children, to describe the impact of CFE and VFSS on feeding recommendations and to evaluate clinical status one year post VFSS and feeding intervention, as compared to one year prior to VFSS.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Feeding Evaluation and Videofluoroscopy: An Integrative Approach to Feeding Management in Children With Suspected Aspiration

Stafler

Akel

Eshel

et al. 2021

Preprint

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BackgroundVideo fluoroscopy swallow studies (VFSS) are considered gold standard for the diagnosis of aspiration in children but require resources and radiation compared to clinical feeding evaluation (CFE). We evaluated their added value for diagnosis, feeding management and clinical status.MethodsA retrospective single-center cohort study of children aged 0-18 years, referred for VFSS at a tertiary pediatric hospital. Results 113 children, median age (range) 2.2 years (0.1-17.9) successfully completed VFSS. Forty-six (41%) had oropharyngeal aspiration, 9 (8%) overt alone and 37 (33%) including silent aspirations. Underlying medical conditions included clinically suspected aspiration lung disease (ALD), 87 (77%); neurologic disease, 73 (64%); gastrointestinal disease, 73 (64%) and congenital heart disease, 42 (37%), not mutually exclusive. Those with ALD or cerebral palsy were more likely to have aspiration by VFSS, OR 3.2 and 9.8 respectively. Sensitivity and specificity of CFE for VFSS diagnosis of aspiration were 71% and 84% respectively. Feeding recommendations after VFSS differed significantly from those based on prior CFE, p<0.001: The rate of exclusively orally fed children increased from 65% to 79%, p=0.006 and exclusively enterally fed children from 10% to 14%; p=0.005. During the following year, there were significantly less antibiotic courses, as well as total and respiratory admissions. Conclusions In this population of children with a high prevalence of clinically suspected ALD, VFSS refined diagnosis and altered feeding management compared to CFE, with subsequent clinical improvement.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Clinical Feeding Evaluation and Videofluoroscopy: An Integrative Approach to Feeding Management in Children With Suspected Aspiration

Stafler

Akel

Eshel

et al. 2021

Preprint

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“…23 This might be the result of an altered pharyngeal constriction, tongue retraction, or laryngeal displacement. 24 Despite the significance of a good clinical evaluation before endoscopic examination, its low sensitivity for aspiration detection 25 makes it relatively unhelpful for the pediatric pulmonologist. Furthermore, the great frequency of silent aspiration in pediatrics 26 calls for the need of a complementary instrumental study.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and management of aspiration using fiberoptic endoscopic evaluation of swallowing in a Pediatric Pulmonology Unit

Aguirregomezcorta

Osona

Peña-Zarza

et al. 2021

Pediatric Pulmonology

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Background and Objectives: Swallowing disorders lead to chronic lung aspiration.Early detection and treatment of aspiration in children with dysphagia are important to prevent lung damage. Diagnosis of aspiration, which may be silent, requires an instrumental study such as fiberoptic endoscopic evaluation of swallowing (FEES).Despite its usefulness, it is rarely practiced by pediatric pulmonologists. This study aimed to evaluate the feasibility and utility of FEES performed in the pediatric respiratory unit of a tertiary hospital, analyze the clinical characteristics, endoscopic findings and proposed treatments, and identify the factors associated with penetration or aspiration.Methods: Medical records of 373 children with suspected aspiration who were referred to the pediatric respiratory unit for FEES were reviewed retrospectively. Clinical characteristics, FEES findings, and the proposed treatments were analyzed.Results: Laryngeal penetration/aspiration was seen in 47.9% of the patients. The most common associated conditions were neurological disease and prematurity. The most frequently observed endoscopic finding was altered laryngeal sensitivity (36.5%). Intervention was recommended in 54.2% of the patients. Complications were not seen during any of the procedures. The multivariate logistic regression model revealed an independent association between aspiration and alterations in laryngeal sensitivity (odds ratio [OR], 5.68), pharyngeal pooling (OR, 11.47), and post-swallowing food residues (OR, 8.08). Conclusions:The FEES procedure performed by pediatric pulmonologists is a reliable method for diagnosing aspiration in children. It can be safely executed by trained pulmonologists, and significant endoscopic signs other than aspiration can guide in the diagnosis and management recommendations.

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“…110 Diagnosing dysphagia is a challenge, with poor sensitivity and specificity of current diagnostic testing modalities. 111 Management of gastroesophageal reflux in this population is also limited by challenges with diagnostic testing and relies on clinical findings, with conservative measures to control reflux favored over pharmacologic approaches. 112 Given these limitations, several centers initiate prophylactic postpyloric feeding or Nissen fundoplication in infants with severe BPD to minimize the likelihood of aspiration.…”

Section: Nutritionmentioning

confidence: 99%

Bronchopulmonary Dysplasia: Then, Now, and Next

Tracy

Cornfield

2020

Pediatric Allergy, Immunology, and Pulmonology

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Bronchopulmonary dysplasia (BPD) has evolved considerably since its first description over 50 years ago. This review aims to provide a historical framework for conceptualizing BPD and a current understanding of the changing definition, epidemiology, pathophysiology, treatment, and outcomes of BPD. The transdisciplinary approach that led to the initial phenotypic description of BPD continues to hold promise today. Investigators are refining the definition of BPD in light of changes in clinical care and increasing survival rates of very preterm infants. Despite improvements in perinatal care the incidence of BPD continues to increase. There is growing recognition that antenatal risk factors play a key role in the development of BPD. Strategies designed to prevent or limit neonatal lung injury continue to evolve. Defining the phenotype of infants with BPD can meaningfully direct treatment. Infants with BPD benefit from an interdisciplinary approach to longitudinal care with a focus on growth and neurocognitive development. While the ultimate impact of BPD on long-term pulmonary morbidity remains an active area of investigation, current data indicate that most children and adolescents with a history of BPD have a quality of life comparable to that of other preterm infants.

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Presenting Signs and Symptoms do not Predict Aspiration Risk in Children

Abstract: Presenting symptoms are varied in patients with aspiration and cannot be relied upon to determine which patients have aspiration on VFSS. The CFE does not have the sensitivity to consistently diagnose aspiration so a VFSS should be performed in persistently symptomatic patients.

Cited by 52 publications

References 39 publications

Clinical Feeding Evaluation and Videofluoroscopy: An Integrative Approach to Feeding Management in Children With Suspected Aspiration

Clinical Feeding Evaluation and Videofluoroscopy: An Integrative Approach to Feeding Management in Children With Suspected Aspiration

Diagnosis and management of aspiration using fiberoptic endoscopic evaluation of swallowing in a Pediatric Pulmonology Unit

Bronchopulmonary Dysplasia: Then, Now, and Next

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Presenting Signs and Symptoms do not Predict Aspiration Risk in Children

Abstract: Presenting symptoms are varied in patients with aspiration and cannot be relied upon to determine which patients have aspiration on VFSS. The CFE does not have the sensitivity to consistently diagnose aspiration so a VFSS should be performed in persistently symptomatic patients.

Cited by 52 publications

References 39 publications

Clinical Feeding Evaluation and Videofluoroscopy:&nbsp;An Integrative Approach to Feeding Management in&nbsp;Children With&nbsp;Suspected Aspiration

Clinical Feeding Evaluation and Videofluoroscopy:&nbsp;An Integrative Approach to Feeding Management in&nbsp;Children With&nbsp;Suspected Aspiration

Diagnosis and management of aspiration using fiberoptic endoscopic evaluation of swallowing in a Pediatric Pulmonology Unit

Bronchopulmonary Dysplasia: Then, Now, and Next

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Clinical Feeding Evaluation and Videofluoroscopy: An Integrative Approach to Feeding Management in Children With Suspected Aspiration

Clinical Feeding Evaluation and Videofluoroscopy: An Integrative Approach to Feeding Management in Children With Suspected Aspiration