Swallowing function and medical diagnoses in infants suspected of dysphagia

Objective. There has been an increase in infant swallowing disorders as a r esult of improved survival for infants born prematurely or with life-threat ening medical disorders. These infants often have multiple health issues an d an increased risk of respiratory complications. However, there is little understanding of the biomechanics of infant swallowing disorders. Therefore , the objectives of this study were to determine 1) the percentage of dysph agic infants who experience laryngeal penetration, aspiration, or nasophary ngeal backflow; 2) reasons for laryngeal penetration/aspiration; 3) whether infants with laryngeal penetration/aspiration clear their airway; and 4) t he relationship between swallowing disorders and medical diagnoses. Methods. Patients included 43 infants who were referred for videofluoroscop ic swallowing studies in a university-affiliated pediatric medical center. Medical charts were reviewed. The videofluroscopic swallowing studies were recorded on videotape, and each swallow was analyzed for laryngeal penetrat ion, aspiration, nasopharyngeal backflow, cough, airway clearance, and reas on for penetration/aspiration. Statistics included chi (2) for nonparametri c data and measures of central tendency for numeric/timing data. Results. More than half of the infants experienced laryngeal penetration, a spiration, or nasopharyngeal backflow; however, the first occurrence of the se events was after multiple swallows. Only 3 infants experienced laryngeal penetration and aspiration on the first swallow and all 3 had an absent ph aryngeal response. Premature infants experienced significantly more nasopha ryngeal backflow. Material in the pyriform sinuses before pharyngeal swallo wing was associated with penetration/aspiration. In episodes of laryngeal p enetration, all patients were able to clear their airway during the swallow without a cough. Almost all infants (8 of 9) who aspirated did not cough o r clear their airway. Conclusions. This study demonstrated that most infants suspected of dysphag ia showed overt abnormalities: laryngeal penetration, aspiration, and/or na sopharyngeal backflow on the videofluoroscopic swallowing study. Most of th ese infants did not demonstrate abnormalities in the first few swallows but displayed deterioration in swallowing function as they continued to feed. Thus, radiographic assessments in infants must examine multiple swallows. T he high incidence of silent aspiration demonstrates the necessity of a vide ofluoroscopic assessment to evaluate swallowing function in these infants.