703 - Swallowing Biomechanics in Preterm Infants Following the Typical Preterm Feeding Progression

Publication Number: 1680.703

Katlyn McGrattan, University of Minnesota, Eden Prairie, MN, United States; Sara E. Ramel, University of Minnesota Masonic Children's Hospital, North Oaks, MN, United States; Michael Murati, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Eric Hoggard, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Anna Miles, The University of Auckland, Auckland, Auckland, New Zealand; Kelly Dietz, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States

Background: The majority of premature infants will suffer from feeding deficits at some point during their hospital stay. Though these typically resolve by term postmenstrual age (PMA), the persistence of deficits in some infants warrants videofluoroscopic swallow (VFSS) assessment. Interpretation of VFSS results among these infants is often unclear due to the lack of reference values for how healthy, preterm infants without persisting problems perform.

Objective: The aim of this investigation is to elucidate characteristics of swallowing biomechanics among preterm infants following the typical preterm feeding progression.

Design/Methods: Preterm infants whose oral feeding progression followed a typical developmental course underwent a research VFSS during their inpatient hospital stay. Infants with syndromes, genetic anomalies, comorbidities not associated with prematurity, feeding deficits determined by therapists to extend beyond a typical preterm presentation, or clinical indicators of swallowing within one year, were excluded. Charts were reviewed for background medical and feeding history, and exams were analyzed for swallowing biomechanics using BabyVFSSImP. Data were analyzed for the lowest performance exhibited within each component of biomechanics using descriptive statistics, with Pearson’s correlations to examine the relationship between biomechanics, time and PMA.

Results: 19 infants (58% female) with an average gestational age of 33.3 ± 2.3 weeks at birth and PMA of 36.6 ± 1.38 weeks were enrolled in the investigation. At the time of the VFSS infants were consuming an average of 68 ± 27% of their prescribed nutrition by mouth, with 32% taking full oral feeds. Infants commonly initiated their swallow in the pyriform sinuses (89%), exhibited nasal regurgitation (63%), and had a narrow column of contrast between their tongue base and posterior wall (95%) at some point in their VFSS. Penetration was observed in 74% of infants, while aspiration was only seen in 16%. When penetration occurred it was typically intermittent, occurring on 16 ± 18% of swallows. Infants who had more frequent penetration were more likely to aspirate (p=0.04). Interestingly, infants of higher PMA were significantly more likely to score worse in swallowing components pertaining to aspiration (p=0.02) than younger infants.

Conclusion(s): Typically progressing premature infants commonly exhibit what are clinically considered impairments in swallowing. Understanding how these perturbation influence function is critical moving forward.