Chou Yun, Wang Lan-Wan, Lin Chien-Jen, Wang Lin-Yu, Tsai Wen-Hui, Ko Mei-Ju
Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan.
Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan; Department of Biotechnology and Food Technology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
Pediatr Neonatol. 2023 Sep;64(5):547-553. doi: 10.1016/j.pedneo.2022.11.010. Epub 2023 Feb 18.
Infants and children with feeding difficulties have swallowing dysfunction and high risk of aspiration, which could be silent without choking, resulting in recurrent pneumonia and long-term respiratory morbidity. Videofluoroscopic swallow study (VFSS) is a useful tool for real-time visualization of the swallowing process and airway aspiration. This study reported a single-institutional 10-year experience of VFSS in pediatric patients with feeding difficulties and the efficacy of swallowing therapy.
From 2011 to 2020, 30 infants and children with feeding difficulties received VFSS examinations in a medical center at a median age of 19 months (range 7 days-8 years). The images of the swallowing process (oral phase, triggering of pharyngeal swallowing, and pharyngeal phase) under videofluoroscopy were analyzed by a radiologist and a speech-language pathologist. Aspiration severity was assessed from VFSS observations and rated by an eight-point Penetration-Aspiration-Scale (PAS), with higher scores indicating increased severity. Swallowing therapy was performed by experienced speech-language therapists, and follow-up of oral feeding tolerance and risk of aspiration pneumonia was done.
Of the 30 patients, 24 (80%) had neurological deficits. High PAS scores (6-8) were observed in 25 (83.4%) patients, and 22 had a PAS score of 8, indicating silent aspiration. Of the 25 patients with high PAS scores, 19 (76%) had neurological deficits, and 18 (72%) depended on tube feeding at a median age of 20 months. Swallowing problems occurred most frequently during the pharyngeal phase in the patients with high PAS scores. VFSS-based swallowing therapy improved oral feeding ability and reduced aspiration episodes.
Infants and children with swallowing dysfunction and neurological deficits had high risk of severe aspiration. Swallowing problems in the pharyngeal phase were the most common VFSS findings in patients with severe aspiration. VFSS may help guide problem-oriented swallowing therapy to reduce the risk of recurrent aspiration.
存在喂养困难的婴幼儿有吞咽功能障碍且发生误吸的风险高，可能无呛咳表现，进而导致反复肺炎和长期呼吸系统疾病。视频荧光吞咽造影检查（VFSS）是实时观察吞咽过程和气道误吸的有用工具。本研究报告了一家机构10年来对有喂养困难的儿科患者进行VFSS检查的经验以及吞咽治疗的效果。
2011年至2020年，30例有喂养困难的婴幼儿在一家医疗中心接受了VFSS检查，中位年龄为19个月（范围7天至8岁）。放射科医生和言语治疗师分析了视频荧光检查下吞咽过程（口腔期、咽吞咽触发和咽期）的图像。根据VFSS观察结果评估误吸严重程度，并通过八点渗透-误吸量表（PAS）进行评分，分数越高表明严重程度越高。由经验丰富的言语治疗师进行吞咽治疗，并对经口喂养耐受性和误吸性肺炎风险进行随访。
30例患者中，24例（80%）有神经功能缺损。25例（83.4%）患者PAS评分高（6 - 8分），22例PAS评分为8分，提示隐匿性误吸。在25例PAS评分高的患者中，19例（76%）有神经功能缺损，18例（72%）在20个月中位年龄时依赖管饲。PAS评分高的患者在咽期吞咽问题最常见。基于VFSS的吞咽治疗改善了经口喂养能力并减少了误吸发作次数。
有吞咽功能障碍和神经功能缺损的婴幼儿发生严重误吸的风险高。咽期吞咽问题是严重误吸患者最常见的VFSS表现。VFSS可能有助于指导针对性的吞咽治疗以降低反复误吸风险。
