Risk of aspiration pneumonia in paediatric patients with dysphagia who were found to have laryngeal penetration on the instrumental swallow evaluation: a systematic review protocol

Abstract

IntroductionDysphagia affects several children in USA and around the globe. Videofluoroscopic Swallow Study (VFSS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) are the most objective studies to define swallowing function. The presence of tracheal aspiration during VFSS or FEES in children with dysphagia is associated with an increased risk of aspiration pneumonia. However, the association of laryngeal penetration with aspiration pneumonia remains unclear. This systematic review aims to assess the risk of aspiration pneumonia in children with dysphagia with laryngeal penetration on VFSS/FEES and compare it with children with tracheal aspiration and children with neither tracheal aspiration nor laryngeal penetration.Methods and analysisThis study will be a systematic review and meta-analysis. Systematic electronic searches will be conducted on PubMed, EMBASE, Web of Science, CINHAL, Scopus, Cochrane CENTRAL, LILACS and WHO Global Index Medicus. We will include studies published through 6 October 2021. Primary outcome will be the incidence of aspiration pneumonia. Secondary outcomes will be incidence of hospitalisation, paediatric intensive care unit admission, enteral tube requirement, growth, symptoms improvement and mortality. The Cochrane Risk of Bias In Non-Randomised Studies of Interventions tool will be used to assess the risk of bias. Meta-analysis will be used to pool the studies. We will pool dichotomous outcomes to obtain an odd ratio (OR) and report with 95% CI. Continuous outcomes will be pooled to obtain mean difference and reported with 95% CI. Overall grade of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and findings will be presented in a summary of findings table.Ethics and disseminationThis study is a systematic review without contact with patients. Therefore, IRB approval is not required. Authors consent to publishing this review. Data will be kept for review by editors and peer reviewers. Data will be available to general public on request.PROSPERO registration numberCRD42020222145.

Assessment of Incidence of Aspiration Pneumonia in Infants with Cleft Palate

“…TS O-N bacs migrating from the oral to the nasal may be the linchpin in CP patients' nasal flora dysbiosis 10 . However, it was also suggested that by closing the aberrant fissures, cleft palate surgery can restore the normal anatomy and function of the oronasopharynx [11][12][13][14] .…”

Laryngeal Penetration and Risk of Aspiration Pneumonia in Children with Dysphagia—A Systematic Review

“…We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines when reporting this review [ 15 ]. A protocol was developed before the start of the review and published in a peer review journal [ 16 ]. The protocol is registered at the International prospective register of systematic reviews (PROSPERO) website (registration number CRD42020222145).…”

“…We considered exposure to occur (‘yes’) or not occur (‘no’) (laryngeal penetration vs. no laryngeal penetration for consistency). In addition, we considered the degree of laryngeal penetration based on the 8-point penetration–aspiration scale [ 5 , 16 ].…”

“…Comparison : We compared the exposure group to patients who had neither penetration nor aspiration on VFSS or FEES [ 16 ]. We also compared the findings with those of tracheal aspiration in children.…”

“…We employed two librarians on our team, who helped with the literature search. The search strategy was published using a protocol [ 16 ].…”