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Beissel A, Denis A, Laborie S, Pillet F, Gauthier-Moulinier H, Hommey S, Tume LN, Butin M, Touzet S. Impact of a nurse education programme on oral feeding in a neonatal unit. Nurs Crit Care 2024; 29:287-295. [PMID: 36054567 DOI: 10.1111/nicc.12840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Premature neonates often experience feeding difficulties during their hospital stay, and evidence-based interventions have been shown to improve feeding outcomes. AIM This study investigated whether an infant-cue based nurse educational feeding bundle accelerates the achievement of independent oral feeding in neonates in a neonatal intensive care unit. STUDY DESIGN A quality improvement study with a pre, during and post intervention test design. All premature neonates admitted to the unit were eligible. The feeding programme included a four-month nurse training module and nurse coaching. RESULTS A hundred and twenty-five nurses or nurse assistants attended the programme and 706 neonates were included. The median time to independent oral feeding (IOF) was 40, 36 and 37 days, respectively, for pre, during and post intervention. The reduction in time to IOF observed during the post-intervention period compared with the baseline period was significant (HR = 1.32, CI 95%: 1.01-1.74). No difference was noted in the length of hospital stay between the three study periods. CONCLUSIONS An infant-cue based nurse educational feeding bundle can promote earlier achievement of IOF in preterm neonates. RELEVANCE TO CLINICAL PRACTICE This quality improvement study demonstrates the impact that a nurse-driven intervention in neonatal care can have on improving practice. Feeding interventions involve the early introduction of oral feeding, non-nutritive sucking (NNS), and oral motor stimulation, and should be individualized for each neonate. These individualized feeding interventions applied by all nurses and assistant nurses, can facilitate the achievement of earlier independent oral feeding in preterm infants and should be included in neonatal critical care nurse education programs.
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Affiliation(s)
- Anne Beissel
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Angélique Denis
- Université Lyon I, Villeurbanne, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Sophie Laborie
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Fabienne Pillet
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | | | - Sophie Hommey
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Recherche Clinique et Épidémiologique, Lyon, France
| | - Lyvonne N Tume
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Marine Butin
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- International center for research in infectiology, INSERM U1111, CNRS UMR5308, University of Lyon 1, Lyon, France
| | - Sandrine Touzet
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Recherche Clinique et Épidémiologique, Lyon, France
- Université Lyon 1, Research on Healthcare Performance Lab, Lyon, France
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Osborn EK, Alshaikh E, Nelin LD, Jadcherla SR. A decade of evidence: standardized feeding initiative targeting feeding milestones and predicting NICU stays in premature infants in an all-referral level IV NICU. J Perinatol 2023; 43:1105-1112. [PMID: 37117395 PMCID: PMC10147899 DOI: 10.1038/s41372-023-01675-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/10/2023] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Ten-year data from the simplified, individualized, milestone-targeted, pragmatic, longitudinal and educational (SIMPLE) feeding initiative were examined by gestational age (GA) category to characterize the feeding milestones, length of hospital stays (LOHS), annual variability and predictive models for LOHS. STUDY DESIGN Preterm infants (≤32 weeks GA, N = 434) in level-IV NICU had milestone-targeted feeding plans. Continuous data were analyzed for outcomes. RESULTS Over 93% successfully attained full oral feedings. Earlier acquisition of feeding milestones correlated with earlier discharge (P < 0.05). Year-wise analysis showed sustained maintenance of milestones (P < 0.05). Milestones and outcomes (P < 0.001) were significantly correlated with different GA categories. Prediction models for LOHS were derived using GA, BPD, age at full enteral, postmenstrual age (PMA) at 1st and full oral feeds. CONCLUSIONS The SIMPLE feeding program minimized variability and promoted acquisition of feeding milestones consistently. LOHS is predictable using feeding milestones, co-morbidities, GA, and PMA at feeding milestones.
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Affiliation(s)
- Erika K Osborn
- The Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Enas Alshaikh
- The Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Leif D Nelin
- Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sudarshan R Jadcherla
- The Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
- Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
- Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
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Miller AN, Shepherd EG, El-Ferzli G, Nelin LD. Multidisciplinary bronchopulmonary dysplasia care. Expert Rev Respir Med 2023; 17:989-1002. [PMID: 37982177 DOI: 10.1080/17476348.2023.2283120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease in neonates and infants, which often presents with multisystem organ involvement, co-morbidities, and prolonged hospital stays. Therefore, a multidisciplinary chronic care approach is needed in the severest forms of BPD to optimize outcomes. However, this approach can be challenging to implement. The objective of this article is to review and synthesize the available literature regarding multidisciplinary care in infants and children with established BPD, and to provide a framework that can guide clinical practice and future research. AREAS COVERED A literature search was conducted using Ovid MEDLINE, CINAHL, and Embase and several components of multidisciplinary management of BPD were identified and reviewed, including chronic care, team development, team members, discharge planning, and outpatient care. EXPERT OPINION Establishing a core multidisciplinary group familiar with the chronicity of established BPD is recommended as best practice for this population. Acknowledging this is not feasible for all individual centers, it is important for clinical practice and future research to focus on the development and incorporation of national consulting services, telemedicine, and educational resources.
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Affiliation(s)
- Audrey N Miller
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital and Division of Neonatology, Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Edward G Shepherd
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital and Division of Neonatology, Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | - George El-Ferzli
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital and Division of Neonatology, Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Leif D Nelin
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital and Division of Neonatology, Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
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Effect of maternal voice on proportion of oral feeding in preterm infants. J Perinatol 2023; 43:68-73. [PMID: 35982244 DOI: 10.1038/s41372-022-01493-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the impact of maternal voice exposure on oral feeding in preterm infants. STUDY DESIGN Prospective, unblinded, 2-center intervention study of infants born 28 0/7-34 6/7 weeks gestation. Infants were exposed twice daily to maternal voice for 20 min before attempting oral feeding. Feedings were divided into groups consisting of Baseline, Intervention, and Follow-up feeds. The study was registered at clinicaltrials.gov (NCT05181020). RESULT 29/37 (78%) mother-infant dyads consented for the study. 25 infants with 2051 feedings were included. Compared to the preceding Baseline, Intervention feeds were associated with an adjusted 7.1 percentage-point increase in oral intake (p = 0.036) and in post-hoc analysis a 71% increased likelihood of having the highest feeding readiness score (p = 0.003). CONCLUSION Exposure to maternal voice prior to enteral feeding is feasible and was associated with significantly improved oral feeding proportions in preterm infants. CLINICAL TRIAL REGISTRY clinicaltrials.gov (NCT05181020).
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Kaspy KR, Burg G, Garrison AP, Miller CK, Pentiuk S, Smith MM, Benscoter D. The follow up of complex infants in an aerodigestive clinic. Paediatr Respir Rev 2022; 44:3-10. [PMID: 36411238 DOI: 10.1016/j.prrv.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/28/2022] [Indexed: 12/17/2022]
Abstract
The current available literature evaluating pediatric multidisciplinary aerodigestive programs for the management of aerodigestive disorders in infants was reviewed. Multidisciplinary aerodigestive programs have emerged to provide coordinated and comprehensive care for the growing population of children with aerodigestive conditions, including complex airway, pulmonary, gastrointestinal, and feeding disorders, which are prevalent among infants discharged from the neonatal intensive care unit (NICU). The team approach central to aerodigestive clinics offers a comprehensive diagnostic workup and unified management plan through consolidated interdisciplinary clinics, combined endoscopic procedures, and regular team discussions, leading to improved resource utilization and health care outcomes. We review common conditions presenting in the NICU that benefit from the aerodigestive model of care, including esophageal atresia, prematurity, bronchopulmonary dysplasia with or without tracheostomy or ventilator dependence, and dysphagia.
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Affiliation(s)
- Kimberley R Kaspy
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Gregory Burg
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
| | - Aaron P Garrison
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Claire K Miller
- Aerodigestive and Esophageal Center, Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Scott Pentiuk
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Matthew M Smith
- Division of Pediatric Otolaryngology Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Dan Benscoter
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
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Arora I, Bhandekar H, Lakra A, Lakra MS, Khadse SS. Filling the Gaps for Feeding Difficulties in Neonates With Hypoxic-Ischemic Encephalopathy. Cureus 2022; 14:e28564. [PMID: 36185935 PMCID: PMC9521296 DOI: 10.7759/cureus.28564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/28/2022] [Indexed: 11/25/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) in neonates poses long-term feeding difficulties and abnormalities of swallowing, the sequel of which is growth impairment. Such infants are also at risk of impaired self-feeding in the grown-up stage along with other motor and tone abnormalities leading to malnutrition and multiple aspiration pneumonia episodes. The lack of evidence-based and pragmatic feeding strategies in such neonates is because of varied unrecognized symptoms and lacking validated diagnostic approaches. This article approaches evidence related to the pathophysiologic basis of feeding difficulties in neonates with HIE as well as standardizing measures and techniques to improve the feeding abilities of such babies and, in turn, their long-term development. The present review provides a scaffold for putting importance on this less taken care issue of feeding problems and emphasizes that more objective and evidence-based studies are required to be added to the literature for early interventions and management of this issue so that caregivers and neonatologists are not misguided by crude subjective opinions.
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Hasenstab KA, Jadcherla SR. Evidence-Based Approaches to Successful Oral Feeding in Infants with Feeding Difficulties. Clin Perinatol 2022; 49:503-520. [PMID: 35659100 DOI: 10.1016/j.clp.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Infants in the neonatal intensive care unit (NICU) frequently have feeding difficulties with the root cause remaining elusive to identify. Evaluation of the provider/parent/infant feeding process may provide objective clues to sources of feeding difficulty. Specialized testing may be necessary to determine if the infant's swallowing skills are dysfunctional, immature, or maldeveloped, and to determine the risk of feeding failure or chronic tube feeding. Current evidence-based diagnostic and management approaches resulting in successful oral feeding in the NICU infant are discussed.
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Affiliation(s)
- Kathryn A Hasenstab
- Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroads, Columbus, OH 43215, USA
| | - Sudarshan R Jadcherla
- Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroads, Columbus, OH 43215, USA; Division of Neonatology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Division Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, USA.
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Osborn EK, Jadcherla SR. Developing a Quality Improvement Feeding Program for NICU Patients. Neoreviews 2022; 23:e23-e35. [PMID: 34970663 DOI: 10.1542/neo.23-1-e23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Practices in NICUs vary widely, particularly when clinical decisions involve complex tasks and multiple disciplines, which occurs with feeding preterm infants. Neonatal feeding difficulties in preterm infants often lead to prolonged tube feeding and therefore lengthened hospital stays. Education and compliance with evidence-based protocols and guidelines are needed on the initiation of feedings and feeding advancement to transform enteral and oral feeding practices and thus reduce practice variation and improve clinical outcomes.
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Affiliation(s)
- Erika K Osborn
- Innovative Neonatal and Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Sudarshan R Jadcherla
- Innovative Neonatal and Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.,Divisions of Neonatology and Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management. CHILDREN 2021; 8:children8121158. [PMID: 34943354 PMCID: PMC8700416 DOI: 10.3390/children8121158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
Preterm infants are known to have long-term healthcare needs. With advances in neonatal medical care, younger and more preterm infants are surviving, placing a subset of the general population at risk of long-term healthcare needs. Oral feeding problems in this population often play a substantial yet under-appreciated role. Oral feeding competency in preterm infants is deemed an essential requirement for hospital discharge. Despite achieving discharge readiness, feeding problems persist into childhood and can have a residual impact into adulthood. The early diagnosis and management of feeding problems are essential requisites to mitigate any potential long-term challenges in preterm-born adults. This review provides an overview of the physiology of swallowing and oral feeding skills, disruptions to oral feeding in preterm infants, the outcomes of preterm infants with feeding problems, and an algorithmic approach to the evaluation and management of neonatal feeding problems.
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Canning A, Clarke S, Thorning S, Chauhan M, Weir KA. Oral feeding for infants and children receiving nasal continuous positive airway pressure and high flow nasal cannula: a systematic review. BMC Pediatr 2021; 21:83. [PMID: 33596866 PMCID: PMC7887825 DOI: 10.1186/s12887-021-02531-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this systematic review was to determine whether introduction of oral feeding for infants and children receiving nasal continuous positive airway pressure (nCPAP) or high flow nasal cannula (HFNC) respiratory support facilitates achievement of full oral feeding without adverse effects, compared to no oral feeding (NPO; nil per oral) on CPAP or HFNC. METHODS A protocol was lodged with the PROSPERO International Prospective Register of Systematic Reviews. We searched Medline, Embase, CINAHL, CENTRAL and AustHealth from database inception to 10th June 2020. Study population included children (preterm to < 18 years) on nCPAP or HFNC who were orally feeding. Primary outcomes included full or partial oral feeding and oropharyngeal aspiration. Secondary outcomes examined adverse events including clinical signs of aspiration, aspiration pneumonia and deterioration in respiratory status. RESULTS The search retrieved 1684 studies following duplicate removal. Title and abstract screening identified 70 studies for full text screening and of these, 16 were included in the review for data extraction. Methods of non-invasive ventilation (NIV) included nCPAP (n = 6), nCPAP and HFNC (n = 5) and HFNC (n = 5). A metanalysis was not possible as respiratory modes and cohorts were not comparable. Eleven studies reported on adverse events. Oral feeding safety was predominantly based on retrospective data from chart entries and clinical signs, with only one study using an instrumental swallow evaluation (VFSS) to determine aspiration status. CONCLUSIONS Findings are insufficient to conclude whether commencing oral feeding whilst on nCPAP or HFNC facilitates transition to full oral feeding without adverse effects, including oropharyngeal aspiration. Further research is required to determine the safety and efficacy of oral feeding on CPAP and HFNC for infants and children. TRIAL REGISTRATION PROSPERO registration number: CRD42016039325 .
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Affiliation(s)
- Angie Canning
- Speech Pathology, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia.
| | - Sally Clarke
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Sarah Thorning
- Library Services, Gold Coast University Hospital, Gold Coast Health, Gold Cost, Australia
| | - Manbir Chauhan
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia
| | - Kelly A Weir
- Allied Health Sciences & Menzies Health Institute Queensland Griffith University, Gold Coast, Australia.,Allied Health Research Gold Coast Health, Gold Coast, Australia
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Gulati IK, Sultana Z, Jadcherla SR. Approach to Feeding Difficulties in Neonates and Infants: A Comprehensive Overview. Clin Perinatol 2020; 47:265-276. [PMID: 32439111 DOI: 10.1016/j.clp.2020.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Deglutition disorders (DD) can be transient and considered as physiologic during normal maturation. However, when oral feeding milestones are impaired and bothersome symptoms and aerodigestive consequences are associated, it is interpreted as DD with varying specific entities, such as feeding difficulties, swallowing disorders, aerodigestive illness, and aspiration syndromes. Symptoms related to DD are heterogeneous and managed empirically. This article clarifies current controversies, explains the potential role of safe feeding and physiologic and pathophysiologic perspectives, and highlights current advances in the field. Evidence basis for diagnostic strategies is discussed, and involves evaluation for structure and function tests, and nutrition and feeding assessment.
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Affiliation(s)
- Ish K Gulati
- Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, OH, USA; Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, College of Medicine, The Ohio State University College of Medicine, Columbus, OH, USA; Center for Perinatal Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 575 Children's Crossroads, Columbus, OH 43215, USA.
| | - Zakia Sultana
- Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, OH, USA; Center for Perinatal Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 575 Children's Crossroads, Columbus, OH 43215, USA
| | - Sudarshan R Jadcherla
- Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, OH, USA; Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, College of Medicine, The Ohio State University College of Medicine, Columbus, OH, USA; Center for Perinatal Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 575 Children's Crossroads, Columbus, OH 43215, USA; Division Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
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