Capturing infant swallow impairment on videofluoroscopy: timing matters.
Capturing infant swallow impairment on videofluoroscopy: timing matters.
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DOI：
10.1007/s00247-019-04527-w
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发表时间：
2020-02
影响因子：
2.3
通讯作者：
Martin-Harris B
中科院分区：
文献类型：
--
作者：
McGrattan KE;McGhee HC;McKelvey KL;Clemmens CS;Hill EG;DeToma A;Hill JG;Simmons CE;Martin-Harris B
婴儿视频透视燕子研究(VFSS)要求临床医生根据有限数量的透视观察到的燕子来确定吞咽缺陷。虽然众所周知，在整个喂奶过程中，呼吸道保护功能会下降，但缺乏关于这种退化时间的数据，限制了最大限度地提高诊断有效性的程序性方案的开发。我们在VFSS的四个标准时间点测试了吞咽生理和呼吸道保护关键组件的稳定性。30名有吞咽障碍临床症状的奶瓶喂养婴儿接受了VFSS。打开透视，在0：00、0：30、1：30和2：30(分：秒[分：S])可以看到五只燕子。我们评估了燕子的吞咽生理成分(口服剂、咽部吞咽开始、吞咽开始时间)和呼吸道保护(穿透、吸入)。我们使用基于模型的线性对比来测试功能成分属性较低的燕子百分比的差异。吞咽生理学的所有组成部分在整个VFSS中都有变化(P≤0.0005)。改变的特点是每次吞咽次数增加(P<；0.0001)，吞咽不完全的燕子百分比(P=0.0005)，咽吞咽开始延迟(P<；0.0001)，吞咽开始时间延迟(P<；0.0004)，吞咽开始时间延迟(P<；0.0001)。这些发现表明，吞咽困难的婴儿在整个视频透视吞咽检查中表现出吞咽生理的变化。仅限于奶瓶喂养的初始吞咽的透视可视化限制了检查的诊断有效性。为婴儿VFSS的执行制定循证程序指南，对于最大限度地提高检查的诊断和治疗效果至关重要。
Infant videofluoroscopic swallow studies (VFSSs) require clinicians to make determinations about swallowing deficits based on a limited number of fluoroscopically observed swallows. Although airway protection is known to decline throughout a bottle-feed, the paucity of data regarding the timing of this degradation has limited the development of procedural protocols that maximize diagnostic validity. We tested the stability of key components of swallow physiology and airway protection at four standardized timepoints throughout the VFSS. Thirty bottle-fed infants with clinical signs of swallow dysfunction underwent VFSS. Fluoroscopy was turned on to allow visualization of five swallows at 0:00, 0:30, 1:30 and 2:30 (minutes:seconds [min:s]). We evaluated swallows for components of swallow physiology (oral bolus hold, initiation of pharyngeal swallow, timing of swallow initiation) and airway protection (penetration, aspiration). We used model-based linear contrasts to test differences in the percentage of swallows with low function component attributes. All components of swallow physiology exhibited a change throughout the VFSS (P≤0.0005). Changes were characterized by an increase in the number of sucks per swallow (P<0.0001), percentage of swallows with incomplete bolus hold (P=0.0005), delayed initiation of pharyngeal swallow (P<0.0001), delayed timing of swallow initiation (P=0.0004) and bolus airway entry (P<0.0001). These findings demonstrate that infants with dysphagia exhibit a change in swallow physiology throughout the videofluoroscopic swallow exam. Fluoroscopic visualization that is confined to the initial swallows of the bottle feed limit the exam’s diagnostic validity. Developing evidence-based procedural guidelines for infant VFSS execution is crucial for maximizing the exam’s diagnostic and treatment yield.
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