Chronic aspiration without gastroesophageal reflux as a cause of chronic respiratory symptoms in neurologically normal infants

Objective: To describe 13 neurologically normal infants with chronic respir atory symptoms who had swallowing dysfunction with silent chronic aspiratio n without gastroesophageal reflux (GER) as the cause of their respiratory s ymptoms. Background: Infants with neurologic disorders and infants with GER are know n to have chronic respiratory symptoms. Isolated swallowing dysfunction and aspiration without GER in neurologically normal infants have not been wide ly reported. Design: Retrospective chart review. S etting: A tertiary pulmonary-care center at a children's hospital. Patients: One hundred twelve otherwise healthy infants referred for respira tory symptoms who underwent esophageal pH studies and videofluoroscopic swa llow studies (VSSs). Methods: The records of infants referred between January 1997 and December 1999 to the Department of Pediatric Pulmonology who underwent 24-h esophage al pH monitoring and VSS as part of an evaluation for recurrent stridor and /or wheezing were reviewed. Significant GER was diagnosed if the percentage of time with esophageal pH < 4 was > 6%. Infants included in the study pre sented with recurrent respiratory symptoms, were born at term, were neurolo gically normal, had normal results of esophageal pH studies, but had abnorm al results of VSSs (n = 13). Results: All 13 infants presented with a variety of recurrent respiratory s ymptoms including wheezing and intermittent stridor. Ten of 13 infants had spitting and/or choking episodes with feeding. The mean (+/- SD) age at the onset of symptoms was 2.0 +/- 1.6 months, and the mean age at VSS was 5.9 +/- 3.4 months. All 13 infants had normal results of 24-h esophageal pH stu dies but had abnormal results for VSSs. All infants had evidence of swallow ing dysfunction and direct silent aspiration of liquids with thin consisten cy. Six infants also were aspirating liquids with thick and/or semi-thick c onsistencies. None of the infants had evidence of structural anomalies on e sophagograms. Nine infants were treated with thickened food, and in four in fants oral feedings were stopped. Three of these infants required nasojejun al feeding, and one infant required gastrostomy tube feeding. VSSs were rep eated every 3 months. In all infants, swallowing dysfunction resolved withi n 3 to 9 months. All infants tolerated the resumption of oral feeding. Vide ofluoroscopic documentation of the resolution of aspiration was followed by the resolution of respiratory symptoms in all infants. Conclusion: There is a subgroup of otherwise healthy infants, presenting wi th wheeze and/or stridor, who have isolated swallowing dysfunction and sile nt aspiration as the cause of their respiratory symptoms.