Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study

Abstract Videofluoroscopy swallow studies (VFSS) and high-resolution manometry (HRM) methods complement to ascertain mechanisms of infant feeding difficulties. We hypothesized that: (a) an integrated approach (study: parent-preferred feeding therapy based on VFSS and HRM) is superior to the standard...

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Autores principales:	Sudarshan R. Jadcherla, Kathryn A. Hasenstab, Erika K. Osborn, Deborah S. Levy, Haluk Ipek, Roseanna Helmick, Zakia Sultana, Nicole Logue, Vedat O. Yildiz, Hailey Blosser, Summit H. Shah, Lai Wei
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/d0d94e13c7324429a7a9f911b8f21c5a
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spelling	oai:doaj.org-article:d0d94e13c7324429a7a9f911b8f21c5a2021-12-02T18:37:11ZMechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study10.1038/s41598-021-99070-w2045-2322https://doaj.org/article/d0d94e13c7324429a7a9f911b8f21c5a2021-10-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-99070-whttps://doaj.org/toc/2045-2322Abstract Videofluoroscopy swallow studies (VFSS) and high-resolution manometry (HRM) methods complement to ascertain mechanisms of infant feeding difficulties. We hypothesized that: (a) an integrated approach (study: parent-preferred feeding therapy based on VFSS and HRM) is superior to the standard-of-care (control: provider-prescribed feeding therapy based on VFSS), and (b) motility characteristics are distinct in infants with penetration or aspiration defined as penetration-aspiration scale (PAS) score ≥ 2. Feeding therapies were nipple flow, fluid thickness, or no modification. Clinical outcomes were oral-feeding success (primary), length of hospital stay and growth velocity. Basal and adaptive HRM motility characteristics were analyzed for study infants. Oral feeding success was 85% [76–94%] in study (N = 60) vs. 63% [50–77%] in control (N = 49), p = 0.008. Hospital-stay and growth velocity did not differ between approaches or PAS ≥ 2 (all P > 0.05). In study infants with PAS ≥ 2, motility metrics differed for increased deglutition apnea during interphase (p = 0.02), symptoms with pharyngeal stimulation (p = 0.02) and decreased distal esophageal contractility (p = 0.004) with barium. In conclusion, an integrated approach with parent-preferred therapy based on mechanistic understanding of VFSS and HRM metrics improves oral feeding outcomes despite the evidence of penetration or aspiration. Implementation of new knowledge of physiology of swallowing and airway protection may be contributory to our findings.Sudarshan R. JadcherlaKathryn A. HasenstabErika K. OsbornDeborah S. LevyHaluk IpekRoseanna HelmickZakia SultanaNicole LogueVedat O. YildizHailey BlosserSummit H. ShahLai WeiNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Sudarshan R. Jadcherla Kathryn A. Hasenstab Erika K. Osborn Deborah S. Levy Haluk Ipek Roseanna Helmick Zakia Sultana Nicole Logue Vedat O. Yildiz Hailey Blosser Summit H. Shah Lai Wei Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study
description	Abstract Videofluoroscopy swallow studies (VFSS) and high-resolution manometry (HRM) methods complement to ascertain mechanisms of infant feeding difficulties. We hypothesized that: (a) an integrated approach (study: parent-preferred feeding therapy based on VFSS and HRM) is superior to the standard-of-care (control: provider-prescribed feeding therapy based on VFSS), and (b) motility characteristics are distinct in infants with penetration or aspiration defined as penetration-aspiration scale (PAS) score ≥ 2. Feeding therapies were nipple flow, fluid thickness, or no modification. Clinical outcomes were oral-feeding success (primary), length of hospital stay and growth velocity. Basal and adaptive HRM motility characteristics were analyzed for study infants. Oral feeding success was 85% [76–94%] in study (N = 60) vs. 63% [50–77%] in control (N = 49), p = 0.008. Hospital-stay and growth velocity did not differ between approaches or PAS ≥ 2 (all P > 0.05). In study infants with PAS ≥ 2, motility metrics differed for increased deglutition apnea during interphase (p = 0.02), symptoms with pharyngeal stimulation (p = 0.02) and decreased distal esophageal contractility (p = 0.004) with barium. In conclusion, an integrated approach with parent-preferred therapy based on mechanistic understanding of VFSS and HRM metrics improves oral feeding outcomes despite the evidence of penetration or aspiration. Implementation of new knowledge of physiology of swallowing and airway protection may be contributory to our findings.
format	article
author	Sudarshan R. Jadcherla Kathryn A. Hasenstab Erika K. Osborn Deborah S. Levy Haluk Ipek Roseanna Helmick Zakia Sultana Nicole Logue Vedat O. Yildiz Hailey Blosser Summit H. Shah Lai Wei
author_facet	Sudarshan R. Jadcherla Kathryn A. Hasenstab Erika K. Osborn Deborah S. Levy Haluk Ipek Roseanna Helmick Zakia Sultana Nicole Logue Vedat O. Yildiz Hailey Blosser Summit H. Shah Lai Wei
author_sort	Sudarshan R. Jadcherla
title	Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study
title_short	Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study
title_full	Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study
title_fullStr	Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study
title_full_unstemmed	Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study
title_sort	mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/d0d94e13c7324429a7a9f911b8f21c5a
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Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study

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