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Response to de Groot et al.

Journal of Perinatology volume 41, pages 1203–1204 (2021)Cite this article

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We thank de Groot et al. [1] for their interest in and feedback on our recent article [2] and for the opportunity to clear up any confusion. Our team agrees with the importance of the clinical bedside assessment and intervention attempts as well as only recommending instrumental assessments when necessary for diagnostic or management purposes [3]. As we described in the discussion section, our comprehensive feeding evaluation begins with a clinical bedside assessment and consultation with the feeding team [2]. Based on the observational findings, compensatory strategies are attempted [4]. Only if the infant continues to demonstrate signs of oropharyngeal dysphagia despite these interventions, and the feeding team determines that an instrumental assessment is medically necessary for appropriate management, does the physician order the instrumental assessment. For the purposes of our research, it was at this time that infants became eligible for study inclusion. Because our research aims were to evaluate FEES and VFSS, the findings from clinical bedside assessments and attempted treatment strategies, while certainly considered in patient management, were outside the scope of the study and were therefore not reported [2, 5].

We also agree that instrumental assessments do not address all of the skills required for oral feeding, and we do not advocate for their indiscriminate use. In our NICU, we perform instrumental assessments on only a small proportion of the infants. Since FEES became a standard of care in our NICU 6 years ago, between 3 and 4% of the infants admitted to the NICU have been evaluated using an instrumental swallowing assessment. We attribute this rate to the success of the feeding team in being able to implement appropriate feeding strategies based on the observational findings of the clinical bedside assessment.

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References

  1. de Groot S, van den Engel-Hoek L, Kalf JG, Harding C. Letter to the editor: comparing videofluoroscopy and endoscopy to assess swallowing in bottle-fed young infants in the neonatal intensive care unit. J Perinatol. 2021.

  2. Armstrong ES, Reynolds J, Carroll S, Sturdivant C, Suterwala M. Comparing videofluoroscopy and endoscopy to assess swallowing in bottle-fed young infants in the neonatal intensive care unit. J Perinatol. 2019;39:1249–56.

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  4. Reynolds J, Carroll S, Sturdivant C. Fiberoptic endoscopic evaluation of swallowing: a multidisciplinary alternative for assessment of infants with dysphagia in the neonatal intensive care unit. Adv Neonatal Care. 2016;16:37–43.

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  5. 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 neo-natal intensive care unit. J Perinatol. 2017;37:404–8.

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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

  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. Mustafa S. Suterwala
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Correspondence to Erika S. Armstrong.

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Armstrong, E.S., Reynolds, J., Carroll, S. et al. Response to de Groot et al.. J Perinatol 41, 1203–1204 (2021). https://doi.org/10.1038/s41372-021-00971-5

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