Fiori Simona, Moretti Elena, Amador Carolina, Martinelli Alice, Scaramuzzo Rosa Teresa, Controzzi Tiziana, Battini Roberta, Filippi Luca, Guzzetta Andrea, Gargani Luna
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
IRCCS Stella Maris Foundation, Pisa, Italy.
Front Pediatr. 2022 Jul 27;10:932409. doi: 10.3389/fped.2022.932409. eCollection 2022.
Infants and children with neurological impairment, such as cerebral palsy (CP), often experience abnormal ingestion functions, including oropharyngeal dysphagia and gastroesophageal reflux disease, which led to aspiration-related respiratory complications, morbidity, hospitalization, or death. There is a lack of evidence-based, repeatable, infant-friendly instrumental procedures to assess aspiration-risk in infants with CP or other neurological disorders, with also a lack of clinical assessment measures to support the use of more invasive diagnostic techniques. To this purpose, in the current study we explore the feasibility of lung ultrasound (LUS), to assess lung deaeration possibly related to aspiration during meal, in a cohort of 35 subjects affected by CP or other encephalopathies, and 10 controls in the same age-range. We coupled LUS procedure with meal caregiver administration for each child. Our results support the feasibility of this innovative approach in the clinical setting. Exploratory findings revealed a number of lung abnormalities likely related to abnormal ingestion function in subjects. Subgroup analyses revealed possible differences in LUS abnormalities between CP and other encephalopathies, possibly related to different mechanism of disease or dysfunction. Also, some evidences arose about the possible relationship between such LUS abnormalities and feeding and swallowing abilities in CP or other encephalopathies. LUS showed preliminarily feasibility and effectiveness in detecting meal-related LUS abnormalities in a dynamic manner in the clinical setting. This approach demonstrated usefulness as a potential tool for improving assessment and management in complex care of infants and young children with severe neurological disorders.
患有神经功能障碍的婴幼儿，如脑性瘫痪（CP），常常会出现异常的摄入功能，包括口咽吞咽困难和胃食管反流病，这些会导致与误吸相关的呼吸并发症、发病、住院或死亡。目前缺乏基于证据的、可重复的、对婴儿友好的器械检查程序来评估患有CP或其他神经疾病的婴儿的误吸风险，同时也缺乏支持使用更具侵入性诊断技术的临床评估措施。为此，在本研究中，我们探讨了肺部超声（LUS）在评估35名患有CP或其他脑病的受试者以及10名同年龄段对照者进餐期间可能与误吸相关的肺去气情况方面的可行性。我们将LUS检查程序与每位儿童进餐时的护理人员管理相结合。我们的结果支持了这种创新方法在临床环境中的可行性。探索性研究结果揭示了一些可能与受试者异常摄入功能相关的肺部异常情况。亚组分析显示CP组和其他脑病组之间在LUS异常方面可能存在差异，这可能与不同的疾病机制或功能障碍有关。此外，还出现了一些关于CP或其他脑病中此类LUS异常与喂养和吞咽能力之间可能关系的证据。LUS初步显示了在临床环境中动态检测与进餐相关的LUS异常的可行性和有效性。这种方法证明了作为一种潜在工具在改善患有严重神经疾病的婴幼儿复杂护理中的评估和管理方面的有用性。
