Videofluoroscopy compared to clinical feeding evaluation in children with suspected aspiration

Acta Paediatr. 2022 Mar 22. doi: 10.1111/apa.16338. Online ahead of print.

ABSTRACT

AIM: Video fluoroscopy swallow studies (VFSS) are gold standard to diagnose aspiration in children but require resources and radiation compared to clinical feeding evaluation (CFE). We evaluated their added value for diagnosis, feeding management and clinical status.

METHODS: A retrospective single-center cross-sectional study of children aged 0-18 years, with respiratory morbidity, referred for VFSS at a tertiary pediatric hospital.

RESULTS: 113 children, median age (range) 2.2 years (0.1-17.9) underwent VFSS. Diagnosis included chronic pulmonary aspiration (CPA), 87 (77%); neurologic, 73 (64%); gastrointestinal, 73 (64%) and congenital heart disease, 42 (37%), not mutually exclusive. Forty-six (41%) aspirated, 9 (8%) only overtly and 37 (33%) including silent aspirations. Those with CPA or cerebral palsy were more likely to have VFSS aspiration, OR 3.2 and 9.8 respectively. Feeding recommendations after VFSS differed significantly from those based on prior CFE, p<0.001: The rate of exclusively orally fed children rose from 65% to 79%, p=0.006; exclusively enterally fed children from 10% to 14%; p=0.005. During the year after VFSS, there were significantly less antibiotic courses, total and respiratory admissions.

CONCLUSION: In this population with high prevalence of clinically suspected CPA, VFSS altered feeding management compared to CFE, and may have contributed to subsequent clinical improvement.

PMID:35316543 | DOI:10.1111/apa.16338

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