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



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.


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.


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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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.


Baylor Health Care System Foundation

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Correspondence to Mustafa S. Suterwala.

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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).

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