Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada.
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Pediatr Pulmonol. 2019 Nov;54(11):1837-1843. doi: 10.1002/ppul.24447. Epub 2019 Jul 16.
Canadian Inuit infants suffer the highest rate of lower respiratory tract infections (LRTI's) in the world. The causes of this are incompletely understood. The primary objective of this study was to determine whether there exists an association between respiratory morbidity and oral aspiration in Inuit children. A retrospective chart review was conducted including children from Nunavut who underwent Video Fluoroscopic Swallowing Study between the years of 2001 to 2015. The primary outcome was hospitalization for LRTI. We hypothesized that infants found to have aspiration would experience a higher rate of admissions for LRTI than those with normal swallowing studies. One-hundred and twenty-seven patients were identified, of whom 94 were included. Fifty-six percent of patients had an abnormal swallowing study. Compared with patients with normal swallowing, the incidence rate of LRTI was higher in patients with aspiration (incidence rate ratio [IRR] = 1.51; 95% confidence interval [CI] = 1.23-1.87) and in patients with penetration (IRR = 1.40; 95% CI = 1.11-1.76). Fourteen percent of patients had confirmed laryngeal cleft; patients with confirmed presence of this also had a higher incidence rate of LRTI (IRR = 1.66; 95% CI = 1.32-2.07). The incidence of abnormal swallowing study showed an 11-fold variation across the five regions in Nunavut, with the highest prevalence in west Qikiqtani Region (Baffin Island). We conclude that swallowing dysfunction is not only prevalent amongst Canadian Inuit but clinically significant. This is the first study to demonstrate an association between swallowing dysfunction and respiratory morbidity in this population. Geographic distribution patterns and high rates of laryngeal cleft may point to a potential genetic etiology for what remains at this point, idiopathic swallowing dysfunction.
加拿大因纽特婴儿的下呼吸道感染（LRTI）发病率居世界首位。其病因尚未完全明确。本研究的主要目的是确定因纽特儿童的呼吸发病率与口腔误吸之间是否存在关联。对 2001 年至 2015 年间在努纳武特接受视频荧光透视吞咽研究的儿童进行了回顾性图表审查。主要结局是因 LRTI 住院。我们假设，有吸入的婴儿因 LRTI 住院的比例会高于吞咽正常的婴儿。共确定了 127 例患者，其中 94 例符合纳入标准。56%的患者吞咽研究异常。与吞咽正常的患者相比，有吸入的患者 LRTI 发病率更高（发病率比 [IRR] = 1.51；95%置信区间 [CI] = 1.23-1.87），有穿透的患者 LRTI 发病率更高（IRR = 1.40；95%CI = 1.11-1.76）。14%的患者有明确的喉裂；有该病症的患者 LRTI 发病率也更高（IRR = 1.66；95%CI = 1.32-2.07）。在努纳武特的五个地区，异常吞咽研究的发生率差异高达 11 倍，其中西基奇塔尼地区（巴芬岛）的发病率最高。我们的结论是，吞咽功能障碍不仅在加拿大因纽特人中很常见，而且具有临床意义。这是第一项证明在该人群中吞咽功能障碍与呼吸发病率之间存在关联的研究。地理分布模式和高喉裂率可能表明，在这一点上仍然是特发性吞咽功能障碍，存在潜在的遗传病因。
