Abstract：
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.
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.
摘要：
背景：喂养困难的婴儿和儿童存在吞咽功能障碍和误吸的高风险，可以保持沉默而不会窒息，导致复发性肺炎和长期呼吸道疾病。视频透视吞咽研究（VFSS）是实时可视化吞咽过程和气道抽吸的有用工具。这项研究报告了在喂养困难的儿科患者中使用VFSS的10年单机构经验以及吞咽疗法的疗效。
方法：从2011年到2020年，30名喂养困难的婴儿和儿童在医疗中心接受了VFSS检查，中位年龄为19个月（7天至8岁）。吞咽过程的图像(口腔阶段，咽部吞咽的触发，和咽期）由放射科医师和言语病理学家在视频透视下进行了分析。根据VFSS观察评估误吸严重程度，并通过8点穿透误吸量表（PAS）进行评分。较高的分数表明严重程度增加。吞咽治疗由经验丰富的语言治疗师进行，并对口服喂养耐受性和吸入性肺炎的风险进行了随访。
结果：在30名患者中，24（80％）有神经功能缺损。在25例（83.4%）患者中观察到高PAS评分（6-8分），22名患者的PAS得分为8分,表明有沉默的愿望.在25名PAS评分高的患者中，19人（76%）有神经功能缺损，18(72%)在中位年龄20个月时依赖于管饲.在PAS评分较高的患者中，咽部阶段最常出现吞咽问题。基于VFSS的吞咽疗法改善了口服喂养能力并减少了误吸发作。
结论：吞咽功能障碍和神经功能缺损的婴儿和儿童发生严重误吸的风险很高。咽期的吞咽问题是严重误吸患者最常见的VFSS表现。VFSS可能有助于指导以问题为导向的吞咽治疗，以降低反复误吸的风险。
方法：从2011年到2020年，30名喂养困难的婴儿和儿童在医疗中心接受了VFSS检查，中位年龄为19个月（7天至8岁）。
结果：在30名患者中，
结论：吞咽功能障碍和神经功能缺损的婴儿和儿童发生严重误吸的风险很高。
