Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
Dysphagia. 2023 Feb;38(1):247-252. doi: 10.1007/s00455-022-10461-1. Epub 2022 May 16.
A retrospective study was performed to evaluate the role of oral feeding (OF) time and sham feeding (SF) on oral-pharyngeal swallowing functions in children with esophageal atresia (EA). Patients with EA were evaluated for age, sex, and types of atresia, time to start OF and surgical complications. Three to six weeks after full OF, videofluoroscopic swallowing evaluation (VFSE) was performed, and Penetration Aspiration Score (PAS, no aspiration = 1, penetration = 2-5, aspiration = 6-8), delay in swallowing reflex and residue after liquid and pudding consistency were noted. Patients were divided into three groups according to repair time; early primary repair (EPR, < 1 month of age), delayed primary repair (DPR, ≥ 1 month of age) and colonic interposition (CI). VFSE findings were compared between groups. In CI group, patients without aspiration in VFSE were encouraged to sham SF before CI. Patients with and without SF in CI group were also compared for oro-pharyngeal dysphagia (OPD). PAS scores were significantly higher in DPR (n = 13) group when compared to CI group (n = 12) in liquid swallowing (p = 0.032) and higher than EPR (n = 30) in pudding consistency (p = 0.03). Patients with CI showed significant OPD when compared to EPR (p = 0.017). Swallowing reflex delay was similar in both groups (p > 0.05). DPR group had significantly higher liquid residue at the level of vallecula (p = 0.028). The residue at other levels (oral, tongue base, pharyngeal wall and pyriform sinus) were similar in all groups in both liquid and pudding consistencies. There was no significant difference between sham-fed (n = 6) and not sham-fed (n = 6) infants in VFSE of OPD (p > 0.05). Patients with DPR without SF had significantly higher incidence of OPD and PAS scores when compared to EPR and CI. Although CI groups has the latest OF time, SF may improve oral motor abilities and cause better OF swallowing functions than patients with delayed repair.
一项回顾性研究评估了经口喂养（oral feeding，OF）时间和假饲（sham feeding，SF）对食管闭锁（esophageal atresia，EA）患儿口咽吞咽功能的作用。评估患者的年龄、性别和食管闭锁类型、开始经口喂养时间和手术并发症。完全经口喂养 3-6 周后，进行视频荧光吞咽评估（videofluoroscopic swallowing evaluation，VFSE），并记录渗透-误吸评分（Penetration Aspiration Score，PAS，无误吸=1，渗透=2-5，误吸=6-8）、吞咽反射延迟和液体及布丁样稠度后残留物。根据修复时间将患者分为三组：早期一期修复（early primary repair，EPR，<1 个月）、延迟一期修复（delayed primary repair，DPR，≥1 个月）和结肠间置术（colonic interposition，CI）。比较各组间 VFSE 结果。在 CI 组中，VFSE 无误吸的患者在 CI 前鼓励进行假饲。比较 CI 组中有和无 SF 的患者的口咽吞咽困难（oropharyngeal dysphagia，OPD）。与 CI 组（n=12）相比，DPR 组（n=13）在液体吞咽时 PAS 评分显著升高（p=0.032），在布丁样稠度时显著高于 EPR 组（n=30）（p=0.03）。与 EPR 组相比，CI 组患者的 OPD 差异有统计学意义（p=0.017）。两组吞咽反射延迟相似（p>0.05）。DPR 组在 vallecula 水平的液体残留量显著较高（p=0.028）。在液体和布丁样稠度时，所有组在口腔、舌根、咽壁和梨状窦水平的残留物相似。VFSE 评估 OPD 时，假饲组（n=6）与非假饲组（n=6）婴儿的差异无统计学意义（p>0.05）。与 EPR 和 CI 相比，无 SF 的 DPR 患者的 OPD 发生率和 PAS 评分显著更高。尽管 CI 组开始经口喂养的时间最晚，但 SF 可能会改善口腔运动能力，并使经口喂养吞咽功能优于延迟修复的患者。
