Using fiberoptic endoscopic evaluation of swallowing to detect laryngeal penetration and aspiration in infants in the neonatal intensive care unit

Abstract

FEES is safe and reliable in assessing laryngeal penetration and tracheal aspiration in NICU infants.

Neonatal swallowing assessment using fiberoptic endoscopic evaluation of swallowing (FEES)

“…To our knowledge the only study on a large group of premature babies <3 months old using FEES is by Suterwala et al which in 2017 compared its results to VFSS and considered FEES safe and reliable in assessing aspiration in NICU infants.…”

“…However, the pediatric studies on FEES only include a small number of infants less than 10 months old . No study has been done on a large group of premature babies of a very young age other than Suterwala et al…”

Clinical Decision Making in the ICU: Dysphagia Screening, Assessment, and Treatment

“…101,102 Descriptions of the procedure in pediatric patients are available 102,103 and the indications for a FEES versus a VFSS are well described in the literature. [103][104][105] FEES is portable to the ICU, safe to complete 106 (even in infants), [107][108][109] and the results show good correlation with those of VFSS. [110][111][112] FEES can be particularly useful in critical care settings, as it can be performed in the patient's room, eliminating potentially difficult patient transport and/or delays to the fluoroscopy suite.…”

Simultaneous Videofluoroscopy and Endoscopy for Dysphagia Evaluation in Preterm Infants—A Pilot Study

“…The data agreement in preterm neonates and infants, however, is unclear. The recent FEES study on preterm infants by Suterwala et al (3) found that the presence and absence of penetration had high agreement using both VFSS (86 and 88%, respectively) and FEES (85 and 72%, respectively). Also, there were high rates of agreement for detecting the absence of aspiration for both VFSS (94%) and FEES (89%).…”

“…However, the greatest advantages of FEES are the avoidance of radiation exposure, ease of use, low ongoing cost, the ability to observe the pharyngeal and laryngeal anatomy directly, evaluate pooling secretions in the pharynx/larynx, as well as the ability to repeat the procedure as frequently as indicated. However, FEES does have some limitations, as the laryngeal elevation during swallowing causes the epiglottis to invert, which can temporarily block the view during endoscopy (white-out period), as well as possible discomfort during endoscopy (3,7). The initial cost of equipment and training necessary to perform FEES is considerable.…”