Capturing infant swallow impairment on videofluoroscopy: timing matters

Katlyn Elizabeth McGrattan, Heather C. McGhee, Keeley L. McKelvey, Clarice S. Clemmens, Elizabeth G. Hill, Allan DeToma, Jeanne G. Hill, Cephus E. Simmons, Bonnie Martin-Harris

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Infant videofluoroscopic swallow studies (VFSSs) require clinicians to make determinations about swallowing deficits based on a limited number of fluoroscopically observed swallows. Although airway protection is known to decline throughout a bottle-feed, the paucity of data regarding the timing of this degradation has limited the development of procedural protocols that maximize diagnostic validity. Objective: We tested the stability of key components of swallow physiology and airway protection at four standardized timepoints throughout the VFSS. Materials and methods: Thirty bottle-fed infants with clinical signs of swallow dysfunction underwent VFSS. Fluoroscopy was turned on to allow visualization of five swallows at 0:00, 0:30, 1:30 and 2:30 (minutes:seconds [min:s]). We evaluated swallows for components of swallow physiology (oral bolus hold, initiation of pharyngeal swallow, timing of swallow initiation) and airway protection (penetration, aspiration). We used model-based linear contrasts to test differences in the percentage of swallows with low function component attributes. Results: All components of swallow physiology exhibited a change throughout the VFSS (P≤0.0005). Changes were characterized by an increase in the number of sucks per swallow (P<0.0001), percentage of swallows with incomplete bolus hold (P=0.0005), delayed initiation of pharyngeal swallow (P<0.0001), delayed timing of swallow initiation (P=0.0004) and bolus airway entry (P<0.0001). These findings demonstrate that infants with dysphagia exhibit a change in swallow physiology throughout the videofluoroscopic swallow exam. Conclusion: Fluoroscopic visualization that is confined to the initial swallows of the bottle feed limit the exam’s diagnostic validity. Developing evidence-based procedural guidelines for infant VFSS execution is crucial for maximizing the exam’s diagnostic and treatment yield.

Original languageEnglish (US)
Pages (from-to)199-206
Number of pages8
JournalPediatric Radiology
Volume50
Issue number2
DOIs
StatePublished - Feb 1 2020

Bibliographical note

Funding Information:
The research team would like to thank the Medical University of South Carolina Department of Radiology for its relentless support in improving pediatric dysphagia care. Without this support this investigation would not be possible. The team would also like to thank Dr. Maureen Lefton-Greif for her insight and contributions to this investigation. This work was supported by a Medical University of South Carolina foundation grant from the Mark and Evelyn Trammell Trust and the National Institute of Deafness and Other Communication Disorders (NIH, NIDCD, R01DC011290, CO-PI: Martin-Harris, Lefton-Greif).

Funding Information:
Dr. Martin-Harris receives grant support from Bracco, is a paid consultant for phagogenesis, receives royalties from the Medical University of South Carolina Foundation for Research Development (Modified Barium Swallow Impairment Profile copyright royalties from Northern Speech Services through an agreement with Medical University of South Carolina), holds a patent for wireless medical sensors and methods, and receives speaker fees from Northern Speech Services. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Funding Information:
The research team would like to thank the Medical University of South Carolina Department of Radiology for its relentless support in improving pediatric dysphagia care. Without this support this investigation would not be possible. The team would also like to thank Dr. Maureen Lefton-Greif for her insight and contributions to this investigation. This work was supported by a Medical University of South Carolina foundation grant from the Mark and Evelyn Trammell Trust and the National Institute of Deafness and Other Communication Disorders (NIH, NIDCD, R01DC011290, CO-PI: Martin-Harris, Lefton-Greif).

Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • Dysphagia
  • Infants
  • Standardization
  • Swallowing
  • Videofluoroscopic swallow studies

PubMed: MeSH publication types

  • Journal Article

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