Fujiki Robert Brinton, Nimtz Abigail, Thibeault Susan L
Department of Surgery, University of Wisconsin-Madison.
Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis.
Am J Speech Lang Pathol. 2025 May 6;34(3):1366-1379. doi: 10.1044/2025_AJSLP-24-00473. Epub 2025 Apr 21.
The purpose of this study was to examine the effects of side-lying and semi-upright positions on videofluoroscopic swallow study (VFSS) outcomes in infants with dysphagia.
A cross-sectional, within-subject design was employed. Infants diagnosed with dysphagia and undergoing VFSS as part of standard of care were prospectively identified at a tertiary care academic children's hospital. Both semi-upright and side-lying positions were assessed with thin liquids using identical bottles/nipples across positions. Severity and frequency of penetration/aspiration and pharyngeal swallow timeliness were rated by three speech-language pathologists specialized in the evaluation and management of pediatric dysphagia. Severity of airway invasion was assessed using the Penetration-Aspiration Scale (PAS) and swallow timeliness using a 3-point ordinal scale. Mixed-level modeling was used to compare swallow outcomes across positions to determine if side-lying was associated with decreased severity and frequency of airway invasion and timelier pharyngeal swallow initiation.
Twenty-one infants diagnosed with oropharyngeal dysphagia were included ( = 4.3 months, = 2.2). Side-lying position was associated with a significant decrease in severity and frequency of penetration/aspiration when compared with semi-upright position ( < .001). Side-lying position was associated with a 91% decrease in the odds of presenting with a more severe PAS rating when compared with semi-upright position (odds ratio = .09, 95% confidence interval = [.03, .21]). Improvements in airway protection in side-lying position were most common in infants with deep penetration/aspiration in semi-upright position. Significantly fewer pharyngeal swallows were initiated at the level of the pyriform sinuses in side-lying position when compared with semi-upright position ( < .001); however, the lowest level of swallow initiation was similar across positions.
Side-lying position in infants with dysphagia was associated with less severe and less frequent penetration/aspiration when compared with semi-upright position. Future research should identify predictors of which infants benefit most from side-lying position, as well as the physiological mechanisms underlying these findings.
本研究旨在探讨侧卧位和半直立位对吞咽困难婴儿视频荧光吞咽造影检查（VFSS）结果的影响。
采用横断面、受试者内设计。在一家三级医疗学术儿童医院前瞻性地确定被诊断为吞咽困难并接受VFSS作为标准治疗一部分的婴儿。使用相同的奶瓶/奶嘴，在半直立位和侧卧位对稀液体进行评估。由三位专门从事儿科吞咽困难评估和管理的言语病理学家对渗透/误吸的严重程度和频率以及咽部吞咽及时性进行评分。使用渗透-误吸量表（PAS）评估气道侵犯的严重程度，使用3分有序量表评估吞咽及时性。采用混合水平模型比较不同体位的吞咽结果，以确定侧卧位是否与气道侵犯的严重程度和频率降低以及咽部吞咽启动更及时有关。
纳入21例被诊断为口咽吞咽困难的婴儿（平均年龄=4.3个月，标准差=2.2）。与半直立位相比，侧卧位时渗透/误吸的严重程度和频率显著降低（P<.001）。与半直立位相比，侧卧位出现更严重PAS评分的几率降低了91%（优势比=0.09，95%置信区间=[0.03,0.21]）。侧卧位气道保护的改善在半直立位时有深度渗透/误吸的婴儿中最为常见。与半直立位相比，侧卧位时梨状窦水平开始的咽部吞咽明显减少（P<.001）；然而，不同体位吞咽启动的最低水平相似。
与半直立位相比，吞咽困难婴儿的侧卧位与较轻的渗透/误吸严重程度和较低的频率有关。未来的研究应确定哪些婴儿从侧卧位中获益最大的预测因素，以及这些发现背后的生理机制。
