Sinais clínicos de disfagia em lactentes com bronquiolite viral aguda

Abstract

Objective:To determine the occurrence of clinical signs of dysphagia in infants with acute viral bronchiolitis, to compare the respiratory parameters during deglutition, and to ensure the intra- and inter- examiners agreement, as well as to accomplish intra and interexaminators concordance of the clinical evaluation of the deglutition. Methods:This was a cross-sectional study of 42 infants aged 0-12 months. The clinical evaluation was accompanied by measurements of respiratory rate and pulse oximetry. A score of swallowing disorders was designed to establish associations with other studied variables and to ensure the intra- and interrater agreement of clinical feeding assessments. Caregivers also completed a questionnaire about feeding difficulties. Significance was set at p<0.05. Results:Changes in the oral phase (prolonged pauses) and pharyngeal phase (wheezing, coughing and gagging) of swallowing were found. A significant increase in respiratory rate between pre- and post-feeding times was found, and it was determined that almost half of the infants had tachypnea. An association was observed between the swallowing disorder scores and a decrease in oxygen saturation. Infants whose caregivers reported feeding difficulties during hospitalization stated a significantly greater number of changes in the swallowing evaluation. The intra-rater agreement was considered to be very good. Conclusions:Infants with acute viral bronchiolitis displayed swallowing disorders in addition to changes in respiratory rate and measures of oxygen saturation. It is suggested, therefore, that infants displaying these risk factors have a higher probability of dysphagia.

Sintomas de disfagia em crianças com fissura labial e/ou palatina pré e pós-correção cirúrgica

“…No statistically significant correlation was found between the symptoms of dysphagia and type of cleft; however, the literature reports data of higher occurrence of feeding problems in trans-and/or post-foramen incisor clefts, in agreement with the findings of the present study (6,8,28) .…”

“…As described in the literature (9,28) , occurrence of coughing, gagging, and vomiting are considered symptoms of dysphagia. Even the term dysphagia is not usually used to refer to eating difficulties in CLP.…”

“…The postoperative occurrence of dysphagia symptoms found in this study, namely, nasal escape, choking, and vomiting, may be associated with the presence of fistulas, from velopharyngeal incompetence and/or insufficiency (8,17,29) . The palatine fistula is a failure in the surgical closure of the palate (28) , and it can be corrected by a new surgical intervention. Velopharyngeal incompetence is caused by decreased velar mobility and insufficiency due to anatomical or iatrogenic changes, which prevent the pharyngeal sphincter from closing (8,17) .…”

Parâmetros cardiorrespiratórios em bebês cardiopatas: variações durante a alimentação

“…Studies show the influence of a POS drop during swallowing as an indicative risk factor for dysphagia (19,20) . It is also known that, as respiratory effort increases and there is a consequent increase in RF, the swallowing sequence can be modified and may be followed by inspiration or apnea, increasing the risk of aspiration (7) . This quantitative data may make clinical speech-language assessment less subjective, after establishment of baseline and expected patterns for each specific population.…”

“…Cardiorespiratory parameters are important data for evaluating the cardiovascular system in infants. Heart rate (HR), respiratory rate (RF) and pulse oximetry data measured by peripheral oxygen saturation (POS) can be observed during swallowing (5,6) and allow the clinical evaluation of deglutition to be more measurable and less subjective (7) .…”