Objectives

Few studies have examined clinical signs of aspiration in infants <51 weeks post-menstrual age (PMA) for whom the laryngeal cough reflex is not fully developed. This retrospective study explored 1) the association between signs of aspiration on a clinical feeding evaluation (CFE) and/or comorbid conditions with aspiration (silent or overt) on a modified barium swallow study (MBS) for infants in this age range, 2) the association between lower respiratory infection (LRI) and aspiration on MBS, and 3) the sensitivity and specificity of detecting aspiration according to signs on CFE and the evaluating speech-language pathologist's (SLP) years of experience.

Methods

A retrospective review of charts of patients with MBS completed January 1, 2012–December 31, 2014 was performed. Patients were included if they were <51-weeks PMA at the time of MBS and had a CFE conducted no more than seven days prior to the MBS. Patient age, comorbidities, and MBS and CFE details were collected. The impact of CFE findings, patient age, comorbid syndromes/associations, and aerodigestive diagnoses on the odds of demonstrating silent aspiration (SA) or overt aspiration during MBS with thin liquids was determined using logistic regression, and the sensitivity and specificity of CFE for identifying SA was calculated.

Results

Results from 114 patients indicated that 46 (40 %) of the infants had SA and nine (8 %) had overt aspiration on MBS. Notable signs on CFEs were cough (36 %), oxygen desaturations (33 %), and chest congestion (32 %). On multiple regression analysis there was increased odds of SA on MBS with at least one clinical sign on CFE (OR: 24.3, p = 0.02), chronic lung disease, (OR: 18.2, p = 0.01), and airway abnormalities (OR: 2.94, p = 0.01). Cough on CFE was associated with increased odds of overt aspiration on MBS (OR: 5.69, p = 0.04). Neither SA nor overt aspiration were significantly associated with LRI. Sensitivity and specificity of CFE for correctly identifying the presence of SA were 98 % and 15 %, respectively; experience of the SLP was not a contributing factor.

Conclusion

Further study is required to determine if specific signs on CFE are predictive of aspiration.

中文翻译：

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临床喂养评估中的婴儿误吸和相关体征

目标

很少有研究对喉部咳嗽反射未完全发育的 <51 周后经期 (PMA) 婴儿的误吸临床症状进行检查。这项回顾性研究探讨了 1) 临床喂养评估 (CFE) 中的误吸迹象和/或该年龄段婴儿的改良钡剂吞咽研究 (MBS) 中的共病与误吸（无声或明显）之间的关联，2)下呼吸道感染 (LRI) 与 MBS 误吸之间的关联，以及 3) 根据 CFE 上的体征和评估语言病理学家 (SLP) 多年经验检测误吸的敏感性和特异性。

方法

对 2012 年 1 月 1 日至 2014 年 12 月 31 日完成的 MBS 患者图表进行了回顾性审查。如果患者在 MBS 时的 PMA 小于 51 周，并且在 MBS 前不超过 7 天进行了 CFE，则包括在内。收集了患者年龄、合并症以及 MBS 和 CFE 的详细信息。使用逻辑回归确定 CFE 发现、患者年龄、合并症/关联和呼吸消化系统诊断对在 MBS 期间用稀薄液体证明无声吸入 (SA) 或明显吸入的几率的影响，以及 CFE 用于识别的敏感性和特异性计算了 SA。

结果

114 名患者的结果表明，46 名 (40 %) 婴儿患有 SA，9 名 (8 %) 婴儿在 MBS 上有明显误吸。CFE 的显着迹象是咳嗽 (36 %)、氧饱和度降低 (33 %) 和胸部充血 (32 %)。在多元回归分析中，存在至少一种 CFE 临床体征（OR：24.3，p = 0.02）、慢性肺病（OR：18.2，p = 0.01）和气道异常（OR： 2.94，p = 0.01）。CFE 咳嗽与 MBS 明显吸入的几率增加有关（OR：5.69，p = 0.04）。SA 和明显误吸与 LRI 均无显着相关性。CFE 正确识别 SA 存在的灵敏度和特异性分别为 98% 和 15%；SLP 的经验不是一个促成因素。

结论

需要进一步研究以确定 CFE 上的特定体征是否可以预测误吸。