Evaluation and Management of Neonatal Dysphagia: Impact of Pharyngoesophageal Motility Studies and Multidisciplinary Feeding Strategy
Evaluation and Management of Neonatal Dysphagia: Impact of Pharyngoesophageal Motility Studies and Multidisciplinary Feeding Strategy
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DOI：
10.1097/mpg.0b013e3181752ce7
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发表时间：
2009-02-01
影响因子：
2.9
通讯作者：
Linscheld, Thomas
中科院分区：
文献类型：
--
作者：
Jadcherla, Sudarshan R.;Stoner, Erin;Linscheld, Thomas
背景和目标：新生儿吞咽异常（吞咽困难）通常使用电视荧光吞咽研究（VSS）进行评估。放射学检查发现经口喂养的高风险包括鼻咽反流、喉部穿透、误吸或淤积。我们的目的是确定新生儿咽食管运动与吞咽困难的相关性以及多学科喂养策略的影响。方法：对 20 名 VSS 结果异常的吞咽困难新生儿（平均妊娠 +/- 标准差 [SD] = 30.9 +/- 4.9 周；中位 31.1 周；范围 = 23.7-38.6 周）进行评估，结果为 49.9 月经后年龄 +/- 16.5 周（中位 41.36 周）。受试者使用微测压导管和气动液压水灌注系统对基础吞咽反射和适应性吞咽反射进行吞咽综合咽食管运动评估。根据运动研究期间的观察，应用了多学科喂养策略，包括姿势适应、感觉改变、饥饿控制和操作性条件反射方法。为了区分经口饲喂器和管饲器之间咽食管测压的相关性，根据出院时的主要喂养方法（经口饲喂与管饲）对数据进行分层。结果：出院时，20 名吞咽困难新生儿中有 15 名成功经口喂养，其余的需要长期管饲。主要口腔喂食者与慢性管喂食者之间的咽食管测压相关性在吞咽频率、吞咽传播、适应性蠕动反射的存在、口腔喂食挑战测试结果和上食管括约肌张力方面存在显着差异（P < 0.05）。 VSS 结果或疾病特征对喂养结果几乎没有影响 (P = NS)。结论：吞咽整合食管运动研究允许在床边受控条件下长期评估吞咽反射和对刺激的反应。功能失调的神经运动机制可能是导致新生儿吞咽困难或其后果的原因。在识别可能在积极的干预计划中取得成功的患者方面，测压法可能是比 VSS 更好的预测指标。 JPGN 48：186-192，2009。
Background and objectives: Abnormal swallowing (dysphagia) among neonates is commonly evaluated using the videofluoroscopic swallow study (VSS). Radiological findings considered high risk for administration of oral feeding include nasopharyngeal reflux, laryngeal penetration, aspiration, or pooling. Our aims were to determine pharyngoesophageal motility correlates in neonates with dysphagia and the impact of multidisciplinary feeding strategy.Methods: Twenty dysphagic neonates (mean gestation +/- standard deviation [SD] = 30.9 +/- 4.9 weeks; median 31.1 weeks; range = 23.7-38.6 weeks) with abnormal VSS results were evaluated at 49.9 +/- 16.5 weeks (median 41.36 weeks) postmenstrual age. The subjects underwent a swallow-integrated pharyngoesophageal motility assessment of basal and adaptive swallowing reflexes using a micromanometry catheter and pneumohydraulic water perfusion system. Based on observations during the motility study, multidisciplinary feeding strategies were applied and included postural adaptation, sensory modification, hunger manipulation, and operant conditioning methods. To discriminate pharyngoesophageal manometry correlates between oral feeders and tube feeders, data were stratified based on the primary feeding method at discharge, oral feeding versus tube feeding.Results: At discharge, 15 of 20 dysphagic neonates achieved oral feeding success, and the rest required chronic tube feeding. Pharyngoesophageal manometry correlates were significantly different (P < 0.05) between the primary oral feeders versus the chronic tube feeders for swallow frequency, swallow propagation, presence of adaptive peristaltic reflexes, oral feeding challenge test results, and upper esophageal sphincter tone. VSS results or disease characteristics had little effect on the feeding outcomes (P = NS).Conclusions: Swallow-integrated esophageal motility studies permit prolonged evaluation of swallowing reflexes and responses to stimuli under controlled conditions at cribside. The dysfunctional neuromotor mechanisms may be responsible for neonatal dysphagia or its consequences. Manometry may be a better predictor than VSS in identifying patients who are likely to succeed in vigorous intervention programs. JPGN 48:186-192, 2009.