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Comparing videofluoroscopy and endoscopy to assess swallowing in bottle-fed young infants in the neonatal intensive care unit

Journal of Perinatology volume 39, pages 1249–1256 (2019)Cite this article

Subjects

Abstract

Objective

To determine the diagnostic accuracy of videofluoroscopy (VFSS) and endoscopy (FEES) in detecting laryngeal penetration and tracheal aspiration in bottle-fed young infants in the NICU.

Study design

VFSS and FEES findings of 22 infants were compared to each other and to a composite reference standard in this prospective study. Sensitivity, specificity, positive and negative predictive values were calculated for each assessment.

Result

Agreement between VFSS and FEES was high (92%) for aspiration and moderate (56%) for penetration, with FEES detecting more instances of penetration. Compared to the composite reference standard, FEES had greater sensitivity and a higher negative predictive value for penetration than VFSS. Because of the low prevalence of aspiration, diagnostic accuracy could not be determined for aspiration for either assessment.

Conclusion

FEES appears to be more accurate in detecting penetration in this population, and both assessments are valuable tools in a comprehensive feeding and swallowing evaluation.

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References

  1. Newman LA, Cleveland RH, Blickman JG, Hillman RE, Jaramillo D. Videofluoroscopic analysis of the infant swallow. Invest Radio. 1991;26:870–3.

    Article  CAS  Google Scholar 

  2. Arvedson J, Rogers B, Buck G, Smart P, Msall M. Silent aspiration prominent in children with dysphagia. Int J Pedia Otorhinolaryngol. 1994;28:173–81.

    Article  CAS  Google Scholar 

  3. Kohda E, Hisazumi H, Hiramatsu K. Swallowing dysfunction and aspiration in neonates and infants. Acta Otolaryngol. 1994;517(Suppl):11–6.

    Article  CAS  Google Scholar 

  4. Taniguchi MH, Moyer RS. Assessment of risk factors for pneumonia in dysphagic children: significance of videofluoroscopic swallowing evaluation. Dev Med Child Neurol. 1994;36:495–502.

    Article  CAS  Google Scholar 

  5. Darrow DH, Harley CM. Evaluation of swallowing disorders in children. Otolaryngol Clin N Am. 1998;31:405–18.

    Article  CAS  Google Scholar 

  6. Friedman B, Frazier JB. Deep laryngeal penetration as a predictor of aspiration. Dysphagia. 2000;15:153–8.

    Article  CAS  Google Scholar 

  7. Newman LA, Keckley C, Petersen MC, Hamner A. Swallowing function and medical diagnoses in infants suspected of dysphagia. Pediatrics. 2001;108:E106.

    Article  CAS  Google Scholar 

  8. Willging JP. Endoscopic evaluation of swallowing in children. Int J Pedia Otorhinolaryngol. 1995;32(Suppl):S107–8.

    Article  Google Scholar 

  9. Hartnick CJ, Hartley BE, Miller C, Willging JP. Pediatric fiberoptic endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol. 2000;109:996–9.

    Article  CAS  Google Scholar 

  10. Leder SB, Karas DE. Fiberoptic endoscopic evaluation of swallowing in the pediatric population. Laryngoscope. 2000;110:1132–6.

    Article  CAS  Google Scholar 

  11. Link DT, Willging JP, Miller CK, Cotton RT, Rudolph CD. Pediatric laryngopharyngeal sensory testing during flexible endoscopic evaluation of swallowing: feasible and correlative. Ann Otol Rhinol Laryngol. 2000;109:899–905.

    Article  CAS  Google Scholar 

  12. Thompson DM. Laryngopharyngeal sensory testing and assessment of airway protection in pediatric patients. Am J Med. 2003;115:166S–8S.

    Article  Google Scholar 

  13. da Silva AP, Lubianca Neto JF, Santoro PP. Comparison between videofluoroscopy and endoscopic evaluation of swallowing for the diagnosis of dysphagia in children. Otolaryngol Head Neck Surg. 2010;143:204–9.

    Article  Google Scholar 

  14. Sitton M, Arvedson J, Visotcky A, Braun N, Kerschner J, Tarima S, et al. Fiberoptic endoscopic evaluation of swallowing in children: feeding outcomes related to diagnostic groups and endoscopic findings. Int J Pedia Otorhinolaryngol. 2011;75:1024–31.

    Article  Google Scholar 

  15. Willette S, Molinaro LH, Thompson DM, Schroeder JW. Fiberoptic examination of swallowing in the breastfeeding infant. Laryngoscope. 2016;126:1681–6.

    Article  Google Scholar 

  16. Suterwala MS, Reynolds J, Carroll S, Sturdivant C, Armstrong ES. Using fiberoptic endoscopic evaluation of swallowing to detect laryngeal penetration and aspiration in infants in the neonatal intensive care unit. J Perinatol. 2017;37:404–8.

    Article  CAS  Google Scholar 

  17. Vetter-Laracy S, Osona B, Roca A, Peña-Zarza JA, Gil JA, Figuerola J. Neonatal swallowing assessment using fiberoptic endoscopic evaluation of swallowing (FEES). Pedia Pulmonol. 2018;53:437–42.

    Article  Google Scholar 

  18. Lambert HC, Gisel EG. The assessment of oral, pharyngeal and esophageal dysphagia in elderly persons. Phys Occup Ther Geriatr. 1997;14:1–25.

    Article  Google Scholar 

  19. McNair J, Reilly S. The pros and cons of videofluoroscopic assessment of swallowing in children. Asia Pac J Speech Lang Hear. 2003;8:93–104.

    Article  Google Scholar 

  20. Langmore SE, Schatz K, Olson N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol. 1991;100:678–81.

    Article  CAS  Google Scholar 

  21. Wu C-H, Hsiao T-Y, Chen J-C, Chang Y-C, Lee S-Y. Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluoroscopic technique. Laryngoscope. 1997;107:396–401.

    Article  CAS  Google Scholar 

  22. Rao N, Brady SL, Chaudhuri G, Donzelli JJ, Wesling MW. Gold-standard? analysis of the videofluoroscopic and fiberoptic endoscopic swallow examinations. J Appl Res. 2003;3:89–96.

    Google Scholar 

  23. Périé S, Laccourreye L, Flahault A, Hazebroucq V, Chaussade S, St Guily JL. Role of videoendoscopy in assessment of pharyngeal function in oropharyngeal dysphagia: comparison with videofluoroscopy and manometry. Laryngoscope. 1998;108:1712–6.

    Article  Google Scholar 

  24. Madden C, Fenton J, Hughes J, Timon C. Comparison between videofluoroscopy and milk-swallow endoscopy in the assessment of swallowing function. Clin Otolaryngol. 2000;25:504–6.

    Article  CAS  Google Scholar 

  25. Giraldo-Cadavid LF, Leal-Leaño LR, Leon-Basantes GA, Bastidas AR, Garcia R, Ovalle S, et al. Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope. 2017;127:2002–10.

    Article  Google Scholar 

  26. Delaney AL, Arvedson JC. Development of swallowing and feeding: prenatal through first year of life. Dev Disabil Res Rev. 2008;14:105–17.

    Article  Google Scholar 

  27. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.

    Article  Google Scholar 

  28. Sim J, Wright CC. The kappa statistic in reliability studies: Use, interpretation, and sample size requirements. Phys Ther. 2005;85:257–68.

    PubMed  Google Scholar 

  29. Colodny N. Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (FEES) using the penetration-aspiration scale: a replication study. Dysphagia. 2002;17:308–15.

    Article  Google Scholar 

  30. Raol N, Schrepfer T, Hartnick C. Aspiration and dysphagia in the neonatal patient. Clin Perinatol. 2018;45:645–60.

    Article  Google Scholar 

  31. Lee JH, Chang YS, Yoo HS, Ahn SY, Seo HJ, Choi SH, et al. Swallowing dysfunction in very low birth weight infants with oral feeding desaturation. World J Pedia. 2011;7:337–43.

    Article  Google Scholar 

  32. Uhm KE, Yi SH, Chang HJ, Cheon HJ, Kwon JY. Videofluoroscopic swallowing study findings in full-term and preterm infants with dysphagia. Ann Rehabil Med. 2013;37:175–82.

    Article  Google Scholar 

  33. Park WY, Lee TH, Ham NS, Park JW, Lee YG, Cho SJ, et al. Adding endoscopist-directed flexible endoscopic evaluation of swallowing to the videofluoroscopic swallowing study increased the detection rates of penetration, aspiration, and pharyngeal residue. Gut Liver. 2015;9:623–8.

    PubMed  Google Scholar 

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Acknowledgements

The authors are grateful to Monica Bennett, Gabriella Cantu, Elisa Priest, Simon Driver, Mary DeHaas, Rachel King, Misty Kyle, Jennifer Hendrikse, Lisa Tiltges and the Baylor Health Care System Foundation for their contributions to the study. We are particularly grateful to Dr. Nazeeh Hanna for his review and feedback on an earlier version of this manuscript.

Funding

Baylor Health Care System Foundation

Author information

Authors and Affiliations

  1. Department of Communication Sciences and Oral Health, Texas Woman’s University, Denton, TX, USA

    Erika S. Armstrong

  2. Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA

    Jenny Reynolds, Sandra Carroll & Chrysty Sturdivant

  3. Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, TX, USA

    Mustafa S. Suterwala

Authors
  1. Erika S. Armstrong
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  2. Jenny Reynolds
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  3. Sandra Carroll
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  4. Chrysty Sturdivant
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  5. Mustafa S. Suterwala
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Corresponding author

Correspondence to Mustafa S. Suterwala.

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The authors declare that they have no conflict of interest.

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ClinicalTrials.gov ID: NCT02003287

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Armstrong, E.S., Reynolds, J., Carroll, S. et al. Comparing videofluoroscopy and endoscopy to assess swallowing in bottle-fed young infants in the neonatal intensive care unit. J Perinatol 39, 1249–1256 (2019). https://doi.org/10.1038/s41372-019-0438-2

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