49 - Incidence and factors associated with the development of dysphagia in infants born very preterm or very low birth weight

Publication Number: 2046.49

Jenny Reynolds, Baylor University Medical Center, Dallas, TX, United States; Mustafa Suterwala, Texas A&M Health Science Center College of Medicine, Dallas, TX, United States; Arpitha Chiruvolu, Baylor University Medical Center, Dallas, TX, United States; Sujata Desai, Pediatrix Medical Group, Dallas, TX, United States

Background: Infants born very preterm (VP) or very low birth weight (VLBW) are at higher risk for developing dysphagia (difficulty with feeding and swallowing) compared to the infants born at older gestational ages. They frequently experience difficulties in achieving full oral feeding in the neonatal intensive care unit (NICU) due to the immaturity of neurological, cardiorespiratory and gastrointestinal functions and their inability to coordinate sucking, breathing and swallowing. Early identification and intervention of feeding issues are crucial for improving long-term outcomes and decreasing dysphagia-induced sequelae. However, the incidence of dysphagia and the factors associated with it are not well-defined in the contemporary VP or VLBW population.

Objective: 1) To determine the incidence of dysphagia in infants born VP or VLBW; 2) to evaluate the perinatal and postnatal factors associated the development of dysphagia; and 3) to report the incidence of interventions to diagnose and manage dysphagia.

Design/Methods: In this retrospective cohort study of infants born VP or VLBW during the two-year time period of 7/1/2019 to 6/30/2021, 40 infants (25.3%) with dysphagia were compared with 118 infants with no dysphagia. The infants with dysphagia demonstrated poor oral feeding progression and clinical signs of swallow dysfunction. In this study, the diagnosis of dysphagia was made by presence of laryngeal penetration and/or tracheal aspiration during instrumental assessment, Fiberoptic Endoscopic Evaluation of Swallowing (FEES).

Results: There were no significant differences in the maternal characteristics between the two groups. The median gestational age and birth weight were significantly lower in infants who developed dysphagia than in those who did not. (Table 1) Logistic regression, adjusting for birth weight and gestational age, showed infants with dysphagia had significantly increased incidence of other morbidities such as necrotizing enterocolitis, bronchopulmonary dysplasia, and intracranial hemorrhage. (Table 2) Multiple regression analyses indicated that dysphagia significantly influenced the central line days and NICU length of stay. (Table 3) The median post menstrual age of FEES exam was 38.4 weeks (37.4 - 40.1). Aspiration on thin liquids (breastmilk or formula) was detected in 23 infants (57.5%). Feeds were thickened in 38 infants (95%) and gastrostomy tube was needed upon discharge in 3 infants (7.5%).

Conclusion(s): Dysphagia occurs in a quarter of infants who are born VP or VLBW. Knowledge of the factors associated with development of dysphagia may help in early diagnosis and intervention.

Table 3
table 3.jpegMultiple regression after adjusting for birth weight and gestational age

Table 2
table 2.jpegNeonatal outcomes

Table 1
Neonatal characteristics and nutrition data