JReynolds PreCon Presentation NANT10 · 2020-04-24 · e ed í ì ð l î ð l î ì î ì...
Transcript of JReynolds PreCon Presentation NANT10 · 2020-04-24 · e ed í ì ð l î ð l î ì î ì...
NANT 10 4/24/2020
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FEES EXPANSION TO NEW POPULATIONS:
WHAT’S IN THE EVIDENCE?NANT 10 Conference
Jenny Reynolds, MS CCC-SLP, CNT, CLC, BCS-S
DISCLOSURES
FINANCIAL
Salary from Baylor Scott and White Institute for Rehabilitation
NON-FINANCIAL
Member of NANT National Professional Collaborative
FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING
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HISTORY OF FEESFEES
Adult
Langmore, Schatz, Olsen(1988,1991)
Bastian
(1991, 1993)
Langmore(2001)
Pediatric
Willging
(1995, 2000)
Willging, Miller, Hogan, Rudolph
(1996)
Hartnick, Miller, Willging(2000)
The study can be performed safely in children as young as premature infants & in adults. (Willging & Thompson, 2005)
Hartnick, Hartley, Miller, & Willging (2000) • 643 FEES on 568 patients• 3 days to 21 years (M=2.5 years)
Leder & Karas (2000) • 30 patients• 11 days to 20 years (M=10.3 yrs)
da Silva, Lubianca Neto, & Santoro (2010) • 30 patients• 10.5 mos to 37.3 mos (M=25.8 mos)
Leder, Baker, & Goodman (2010) • 14 patients• 3 mos to 14 mos (M=8.5 mos)
Sitton, et al. (2011) • 79 patients• 12 days to 170 mos (M=26 mos)
Beer, Hartlieb, Müller, Granel, & Staudt (2014)
• 30 patients• 10 mos to 17 years (M=5 years)
Ahmed-Abdelhamid & Sarwat (2016) • 64 patients/controls• 2 mos to 168 mos (M=41-49 mos)
FEES SAFETY: PEDIATRICS & INFANTS
INTER-RATER RELIABILITY VFSS FEESPENETRATION ASPIRATION PENETRATION ASPIRATION
Leder & Karas (2000)• 30 children• 7 had both VFSS & FEES
100% 100% 100% 100%
da Silva, Lubianca Neto, & Santoro (2010)• 30 children• 2 reviewers
n/a n/a 87% 90%
PEDIATRIC VFSS & FEES
COMPARATIVE EFFECTIVENESS (not completed simultaneously)
PENETRATION ASPIRATION
Leder & Karas (2000)• 7 children
100% 100%
da Silva, Lubianca Neto, & Santoro (2010)• 30 children• 2 reviewers
53% / 60% 53% / 50%
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Willette, Molinaro, Thompson, & Schroeder (2015)
• 26 FEES exams on 23 breastfeeding infants• 13 days to 10 months
• No major complications• No significant oxygen desaturation• No respiratory or cardiac distress, cyanosis, or need for additional support• No epistaxis that required intervention
“FEES is safe, well tolerated, & easy to perform…for infants”
FEES WITH BREASTFEEDING INFANTS
FEES IN THE NICU
Determining the efficacy of
using FEES compared to
VFSS to diagnose laryngeal
penetration & aspiration in
infants in the NICU
Suterwala, Reynolds, Carroll, Sturdivant, Armstrong 2017Journal of Perinatology
“Fiberoptic Endoscopic Evaluation of Swallowing to detect laryngeal penetration and aspiration in infants in the neonatal care unit”
Can FEES assess swallowingduring breastfeeding?
How does FEES compare to the VFSS with infants?
Is FEES safe, reliable, & effective with infants in the NICU?
SUTERWALA, et al 2017
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STUDY PARTICIPANTS
• Inpatient in BUMC NICU• Mean gestational age: 39.9 weeks (range 37-49 wks)• 10 males; 15 females
25 INFANTS25 INFANTS
• Bedside clinical exam suggested aspiration• Able to undergo both FEES & VFSS• No bilateral complete cleft lip & palate
CRITERIACRITERIA
• IRB approved• Parental informed consent obtained
IRBIRB
SUTERWALA, et al 2017
CHARACTERISTIC N (%)
Patent ductus arteriosus - ligation 4 (16%)
Intraventricular hemorrhage 8 (32%)
Surgical necrotizing enterocolitis 1 (4%)
Respiratory distress syndrome 19 (76%)
Gastroesophageal reflux disease 4 (16%)
Nasogastric tube 22 (88%)
Oxygen nasal cannula 16 (64%)
MEDICAL CHARACTERISTICS
SUTERWALA, et al 2017
STUDY DESIGNVFSS or FEESVFSS or FEES
VFSS or FEESVFSS or FEES
Breastfeeding FEES
Breastfeeding FEES
SUTERWALA, et al 2017
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STUDY DESIGN
on penetration/aspiration findings
BEFORE VFSS & FEES
• Vital signs within 10 minutes
before scoping & within 5 minutes
after feeding
• Standard protocol varying the
nipple type & consistency based
on penetration/aspiration findings
AFTER VFSS & FEES
• Two SLPs reviewed recordings &
documented
penetration/aspiration (blinded)
• Reached consensus for
FEES/VFSS comparison
SUTERWALA, et al 2017
RESULTS: SAFETY
No adverse events or major
complications during the study (e.g., epistaxis or
laryngospasm)
No adverse events or major
complications during the study (e.g., epistaxis or
laryngospasm)
No infant demonstrated any major instance of
autonomic instability
No infant demonstrated any major instance of
autonomic instability
SUTERWALA, et al 2017
RESULTS: SAFETYPre-Feeding Post-Feeding p-value
Respiratory Rate
Mean ± std 52.7 ± 10.8 50.8 ± 18.9 0.6204
Range 31-78 21-107
Heart Rate (bpm)
Mean ± std 163 ± 14 168 ± 15 0.1100
Range 128-184 130-188
O2 Saturation (%)
Mean ± std 97.5 ± 2.6 95.1 ± 9.6 0.2207
Range 92-100 52-100
SUTERWALA, et al 2017
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RESULTS: INTER-RATER RELIABILITY
ASSESSMENT n PENETRATION ASPIRATION
VFSS 78 87% 90%
FEES 66 80% 80%
PENETRATION ASPIRATION
Presence Absence Presence Absence
VFSS 86% 88% 43% 94%
FEES 85% 72% 0% 89%
SUTERWALA, et al 2017
PENETRATION (56%) VFSS
FEES Yes No
Yes 13 (26%) 18 (36%)No 4 (8%) 15 (30%)
ASPIRATION (92%) VFSS
FEES Yes No
Yes 1 (2%) 1 (2%)No 3 (6%) 45 (90%)
RESULTS: AGREEMENT BETWEEN VFSS & FEES BY CONSISTENCY TRIAL (N=50)
ARMSTRONG, et al. 2019“Comparing Videofluoroscopy and endoscopy to assess swallowing in bottle-fed young infants in the NICU”Journal of Perinatology
FEES: INFANTS IN THE NICUVetter-Leracy et al (2018)
Aims of the Study:• Determine # of premature infants with desaturations during feeding due to aspiration using FEES• Relate clinical factors and FEES findings to aspiration• Describe type and efficiency of suggested treatments
Methods:• Retrospective review of 62 premature infants• Median PMA 40 weeks• Underwent FEES for persistent desaturation during feeding (after >36 weeks PMA)• Compared recordings of desaturations during feedings 7 days before and after the FEES
Results: • 44 of the infants (71%) - penetration and/or aspiration was identified.• No relation was found to demographic or clinical data• Accumulation of saliva and residues post swallowing were related to aspiration (P<0.01)• Use of a thickener reduced aspiration during FEES on 77% of the infants• 9.1% of infants required gastrostomy tube
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BREASTFEEDING FEES
Armstrong, Reynolds, Sturdivant, Carrroll, Suterwala 2019
• Purpose: Safety and feasibility of FEES in NICU infants during breastfeeding• 5 infants recruited• 37 weeks PMA or above
• Results:• Mean PMA of 39.8 weeks• No adverse events• No statistically significant differences between
pre-feeding & post-feeding vital signs• Human milk was observable during swallows• Penetration was identified in one infant• Further study is needed
“Assessing Swallowing of the Breastfeeding NICU Infant Using FEES: A Feasibility Study”
National Association of Neonatal Nursing
CLINICAL INDICATIONS FORINFANT FEES:
BOTTLE AND BREASTFEEDINGNANT 10 Conference
Jenny Reynolds, MS CCC-SLP, CNT, CLC, BCS-S
DEFINING NEONATAL & INFANT FEES
INFA
NT
FE
ES
INFA
NT
FE
ES
FUNCTIONALFUNCTIONAL
ENTIRE FEEDING IF TOLERATED/NEEDEDENTIRE FEEDING IF
TOLERATED/NEEDED
LIVE TIME INTERVENTIONS/STRATEGIES
LIVE TIME INTERVENTIONS/STRATEGIES
POSITIONINGPOSITIONING
EQUIPMENTEQUIPMENT
VISCOSITYVISCOSITY
FAMILY CENTEREDFAMILY CENTERED
INCREASE COMPETENCE & CONFIDENCE
INCREASE COMPETENCE & CONFIDENCE
LIVE TIME
EDUCATION & FEEDBACK
LIVE TIME
EDUCATION & FEEDBACK
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NEONATAL & INFANT FEES
ADVANTAGES No barium
No radiation
Bedside evaluation
HD view of structures
No time constraints
Family centered
Cost effective
Real-time evaluation of interventions
Simulates true feeding environment
Safe evaluation of bottle feeding & breastfeeding
DISADVANTAGES
Possible discomfort to patient
Specialized training needed
Unable to assess oral/esophageal phases of swallowing
Chain Swallows in infants can be difficult to interpret
White out during the swallow causing inability to view entire swallow sequence
Equipment cost
FEES IN INFANTS & CHILDREN: Protocol, Safety, Clinical Efficacy25 Years of ExperienceMiller & Willging 2019
Indications for Pediatric FEES
Readiness for oral feeding trials needs to be determined; patient is NPO or takes negligible oral intake
Suspected difficulty with oral secretion management
Known or suspected structural abnormality in the pharynx or larynx with possible impact on swallowing function
Abnormal videofluoroscopic swallowing study results; need more information about pharyngeal/laryngeal anatomy, function, and sensory threshold
Need to assess patient ability to achieve and sustain supraglottic and glottic closure; need to assess vocal fold mobility
Alternative to close interval videofluoroscopic examinations if appropriate, to avoid repeated radiation exposures
Contraindications for Pediatric FEES:
Complete choanal atresia, nasal obstruction
Significant pharyngeal stenosis precluding adequate view during FEES
Severe micrognathia and glossoptosis
Significant medical fragility
FEES IN INFANTS & CHILDREN: Protocol, Safety, Clinical Efficacy25 Years of ExperienceMiller & Willging 2019 DIAGNOSTIC CATEGORIES OF PATIENTS UNDERGOING PEDIATRIC FEES
STRUCTURALCraniofacial anomalies, syndromes with craniofacial component
Pharyngeal stenosisLaryngeal anomalies: laryngomalacia, vallecular cyst, vocal fold paralysis, laryngeal web, laryngeal
cleft, subglottic stenosisTracheoesophageal fistula/Esophageal Atresia status post repair
FUNCTIONAL DISORDERS OF THE ESOPHAGUSCaustic ingestion injuries
Cricopharyngeal DysfunctionCricopharyngeal Achalai
NEUROLOGIC ETIOLOGIESPrematurity and swallowing dysfunction
Periventricular leukomalaciaHypoxic Ischemic Encephalopathy (HIE)
Anoxic Encephalopathy (respiratory arrest, drowning)Cerebral Palsy: spastic, athetoid, ataxic, mixed types
Chiari malformation (Type I and Type II)Brain tumors: astrocytoma, brainstem glioma, ependymoma, germ cell tumor, medulloblastoma •• Leukodystrophy
Pediatric cerebrovascular accident (CVA)Abnormalities of the corpus collosum
Peripheral nerve diseases (muscular dystrophies, congenital myopathies, spinal muscular atrophy, infant botulism
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FEES IN INFANTS & CHILDREN: Protocol, Safety, Clinical Efficacy25 Years of ExperienceMiller & Willging 2019
DIAGNOSTIC CATEGORIES OF PATIENTS UNDERGOING PEDIATRIC FEES (continued)
CARDIORESPIRATORY CONDITIONSCongenital heart defects affecting coordination of respiration and swallowing: atrial septal
defect, aortic valve stenosis, atrioventricular canal defect, coarctation of the aorta, Ebstein anomaly, hypoplastic left heart syndrome, interrupted aortic arch, patent ductus arteriosus, pulmonary atresia,
pulmonary valvar stenosis, total anomalous pulmonary venous return, transposition of the great arteries, vascular rings, ventricular septal defects, Tetralogy of Fallot
Respiratory distress syndromeMeconium aspiration syndrome
Brief Resolved Unexplained Event in Infants (BRUE)Lower airway disorders: cystic fibrosis, bronchopulmonary dysplasia, pneumonia
METABOLIC DISORDERSUrea cycle defect/disorder
Hereditary fructose intoleranceLyosomal storage diseases
Metabolic myopathyGlycogen storage disease
Mitochondrial disorder
ASSOCIATIONS/SEQUENCES/SYNDROMESCHARGE SyndromeMoebius Syndrome
Smith-Lemli-Opitz SyndromeCornelia de Lange Syndrome
Noonan SyndromeCoffin Sirris SyndromeVACTERL Association
Trisomy 8, 9, 13, 18, 21, 22
BSWH NEONATAL & INFANT FEES CRITERIA
INDICATIONS CONTRAINDICATIONS
Age/Maturity (37 weeks +) and autonomically stable
Autonomic instability at rest
Signs/Symptoms of swallowing dysfunctionduring clinical feeding evaluation & treatment (bottle and/or breastfeeding)
Anatomic considerations:Nasal obstructionChoanal atresia
Stridor/Stertor Consider state regulation
Airway abnormality suspected
Difficulty weaning respiratory support
Assess readiness for oral feedings/secretion management
All compensatory strategies have been attempted (positioning, equipment- slow flow nipple, pacing, etc)
NEONATAL & INFANT FEES TEAM (varies per facility)
TEAM MEMBER ROLEENT • Endoscopist (dependent on facility)
• Reviews all exams after completed by/or with SLP
SLP • Endoscopist (dependent on facility)• Feeding therapist & interpretation of exam• Education to family/staff
NEONATAL FEEDING THERAPIST
• Feeding the infant during the exam• Providing calming strategies to infant• Education to family/staff
LACTATION CONSULTANT Assist mom/infant with positioning and latch in breastfeeding fees
RN Assess infant before, during and after procedure
NEONATOLOGIST Collaboration before, during & after procedure
DIETITIAN Discuss diet preparation before exam
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NEONATAL & INFANT FEES EQUIPMENT
PENTAX MEDICAL
Fiberscope
• 2.4mm• 3.5mm
Videoscope
• 2.4mm• 3.3mm • 3.7mm
OLYMPUS
Fiberscope
• 2.2mm • 3.4mm
Videoscope
• 2.6mm• 3.4mm
STORZ
Fiberscope
• 2.5mm• 2.8mm• 3.5mm
Videoscope
• 2.4 mm• 4mm
ENHACING VISUALIZATION DURING FEES
Enha
nce
Visu
aliz
atio
n
Food Grade DyeFood Grade Dye
AquadexAquadex
BetacarotineBetacarotine
Phagein BluePhagein Blue
TOPICAL ANESTHESIA: CAUTION
CONSIDERATIONS
Pain/comfort during endoscopy
Impact on swallowing function
TYPE APPLICATION
Local anesthetic• Spray• Topical gel applied with cotton
tip applicator
Nasal decongestant
• Spray
PUBLICATIONS
Use of topicalanesthesia
affect swallow function
• Bastian1999
• Hartnick 2000
• Johnson 2003
Topical anesthesia used for patient
comfort but not affect the
swallow
• Lester 2013
• Fife 2015• O’Dea
2015
Use of topical anesthesia does not increase
comfort and tolerance
• Frosh 1998• Leder et al
1997• Singh 1997
TALK TO YOUR PHYSICIAN &
TAKE CAUTION WITH INFANTS
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POSSIBLE COMPLICATIONS
EPISTAXIS
• Self-limiting• Apply Pressure• Cautious Entry
REACTION TO TOPICAL
ANESTHESIA
• Rare• Cautious use
with Infants• Can increase
heart rate/BP
VASOVAGAL RESPONSE
• Patient • Caregiver
LARYNGOSPASM
• Reflexive closure of the glottis
• Generally seen in anesthetized patients
• Low risk in awake state
Aviv, et al. 2000, Aviv, Kaplan & Langmore 2001
NEONATAL FEES PREPARATION
Identify and Plan for FEES
• Comprehensive feeding evaluation• Discuss with team
• Obtain MD order• Parental education
• Schedule• Team pre-huddle
• Prepare infant exam report form
NEONATAL FEES PREPARATION
TEAM HUDDLE FORM
Maternal history
Infant birth history
Infant co-morbidities
Environment
Neurobehavioral
Neuromotor
Sensory
Current diet/method of delivery
Feeding & swallowing evaluation & interventions
Indications for FEES
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NEONATAL FEES SET-UP
Nurse
Prepare the milk
Neonatal Feeding
Therapist
Prepare the infant
Prepare the family
Prepare the environment
Endoscopist
Prepare equipment
Prepare the family
FEES: DURING THE EXAM
Initial insertion of bottle & scope
• NNS and sucrose prior to exam• NT insertion of bottle
• Endoscopist insertion of scope• Anchor important
Begin Assessment
ASSESS NASOPHARYNX
Completed with ENT or reviewed by ENT
Nasopharynx
• Turbinates
• Appearance
• Velum
• Appearance
• Movement
App
eara
nce
Normal/abnormal
Inflammation
Blood
Secretions
Mov
emen
t
Lack of movement
Speed and range of movement
Symmetrical / Asymmetrical
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ASSESS APPEARANCE OF PHARYNX & LARYNX
Completed with ENT or FEES video
reviewed by ENT
• Posterior Pharyngeal Wall
• Base of Tongue
• Vallecula
• Epiglottis
• Vocal folds
• Aryepiglottic folds
• Arytenoids
• Pyriform sinus
App
eara
nce
Normal/abnormal
Symmetry
Inflammation/Edema
Erythema
Supraglottic collapse
Pachydermia
Post cricoid swelling
ASSESS MOVEMENT OF PHARYNX & LARYNXCompleted by ENT or
reviewed by ENT
• Pharyngeal Walls
• Epiglottis
• Vocal folds
• Arytenoids
Mov
emen
t
Normal
Lack of movement
Symmetrical / Asymmetrical
Speed and range of movement
ASSESS SECRETION MANAGEMENT
Se
cre
tion
ma
na
ge
me
nt
Describe appearance
(thick, thin)
Location
Amount
Response to secretions
Swallow frequency
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ASSESS SWALLOWING & STRATEGIES
Assessment with bolus presentations
Swallow response time
Airway protectionPenetration
Aspiration
Response
Residue Degree
Clearance
Response to therapeutic interventions to improve safety of swallow
Positioning
Equipment
Strategies
Viscosity Thickening agent if appropriate
Replicate typicalfeeding position
Try varying flow rates
Pacing
NEONATAL FEES: AFTER THE EXAM
Team Collaboration
• Support family and infant• Determine feeding plan• Follow up consultations
• Family Education• Cleaning scope/equipment
•Consultations (ENT, GI) •Family education•Cleaning scope
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FEES PROCEDURE: BREASTFEEDING
• Multidisciplinary team discussion prior to the procedure• Lactation- anticipatory guidance for mom; assist with positioning of
infant• Neonatal Therapist- assist with positioning of infant; dye
• ENT or SLP- Endoscopist
Verify team rolesVerify team roles
• Mix 2 drops of dye with 10 mL of EBM and deliver with 3 mL syringe• Swab tongue with dye• Paint breast with dye
• Small drops behind nipple shield
Options for visualizationOptions for visualization
• Begin with most practiced position that mom is most comfortable
Position for feeding & scopingPosition for feeding & scoping
• Positioning• Manual Compression
• Nipple shield
During the exam: Attempt StrategiesDuring the exam: Attempt Strategies
BREASTFEEDING FEES: POSITIONING OF ENDOSCOPIST
Position: Football
Endoscopist standing
Position: Football
Endoscopist kneeling
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BREASTFEEDING FEES:LESSONS LEARNED
• Team members roles: CLC/IBCLC involvement
• Anticipatory guidance/education to family
• Handling of scope by endoscopist
• Endoscopist comfort with breastfeeding
• Topical anesthesia on tip of scope (Willette)
INFANT FEES ONLINE SURVEY
Online IRB-approved survey of SLPs conducted in Summer 2018
Invitations to participate were e-mailed and posted to listservs
Participants were encouraged to forward the survey link to colleagues
Anonymous
33 SLPs responded
Presented at ASHA CONVENTION 2018
PRACTICE SETTINGS FOR INFANT FEES % SLPs who
perform infant FEES at each
setting
Average number infant FEES per week per SLP
Average number infant VFSS per week per SLP
Ratio VFSS to FEES
Children’s Hospital NICU 61% 0.97 1.75 1.8
Birthing/Delivery Hospital NICU 18% 0.91 0.94 1.0
Children’s Hospital ICU 48% 0.83 2.12 2.5
Children’s Hospital Non-ICU 55% 1.38 2.58 1.9
Pediatric Inpatient Rehab 24% 0.88 3.60 4.1
Outpatient Setting 58% 3.12 5.21 1.7
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RESULTS: TEAM AND PROCEDURE
Team
ENT passes the scope in most settings
SLP, ENT, Nurse, and Parent are generally present across most settings
Bottle-Feeding Procedure
Parents and other team members hold/feed the infant
Food grade dye most commonly used
Most use no anesthetic
97% reported using compensatory strategies
Breastfeeding
79% of SLPs reported using FEES to assess breastfeeding
RESULTS: ESTABLISHING COMPETENCIES Each facility has its own procedures for establishing
competencies
Variable specifics yet common components:
General knowledge of anatomy and physiology of the infant swallow
Educational didactic course (adult and/or pediatric)
Observation of infant fees
Hands-on training under a clinical mentor (SLP or ENT)
Passing the scope
Interpretation
Completing a set number of passes independently
BENEFITS OF FEES WITH INFANTS
Can complete a longer study and view/assess change over entire feeding and across feedings
View of anatomy
No radiation exposure (interim to avoid repeat VFSS; too many VFSS)
Positioning and strategies more easily attempted/more natural
Beneficial for trach/vent pts or those who have difficulty leaving the floor; easier/flexible scheduling
Breastfeeding
Can assess secretion management
No barium; can use breastmilk/actual milk
Increased interest by nursing staff who support the program
Good for presurgical exam
Ease of exam with parental paradigm remaining intact
Able to review images with family, medical staff, ent easily
Physicians appreciate being able to be present during study or view later
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CHALLENGES OF FEES WITH INFANTS
Calming the infant to latch; maintaining quiet alert state after passing scope and during bottle changes
White out with successive swallows; assumption of aspiration vs. direct observation
Harder to get longer studies with infants older than 3-6 months
Coordinating with ENT to obtain competency or to conduct study; variability of ENT practice/scope placement
Staff and physician acceptance; all agreeing on new feeding plan
Only assessing pharyngeal phase, not esophageal phase
Anatomical abnormalities
Positioning the scope/infant movement
Training can be challenging
Positioning the scope during breastfeeding
Highly sensitive preemie less likely to tolerate the scope
Difficult with nasal cannula/NGT
Inability to acquire highest quality equipment due to funding
“Thank you for the FEES. As a new, first-time mom, I am so grateful for all of the hard work & diligence that everyone at Baylor has put in to take the best
care of my son, Teddy. I especially appreciate everyone involved in the FEES.
I feel so much better knowing for sure how to safely feed my son.”
WHY IT MATTERS…
BSWH NEONATAL FEES PROGRAM
• Transfer to Children’s hospital for further aerodigestive evaluation
• Surgery
• Determining safe and most effective feeding plan
• Understanding more about their infant’s swallow function
• Utilizing techniques for feeding and swallowing
• Breastfeeding• Bottle feeding
Parent Confidence
Parent Competence
Rapid ReferralLength of Stay
305 Bottle feeding FEES procedures in NICU
26 Breastfeeding procedures in NICU
Collecting data and entering into database for analysis
BSWH Infant FEES in the NICU 2013-2020
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FUTURE DIRECTIONS FOR INFANT FEES
More research is needed on the infant population (under 12 months)
Safety
Reliability/validity
Use with breastfeeding
Work toward establishing common guidelines for training and competency
Work toward developing common procedures for infant FEES assessments
THANK YOU! [email protected]
REFERENCES Langmore, Susan E., Schatz MA Kenneth, and Nels Olsen. "Fiberoptic endoscopic
examination of swallowing safety: a new procedure." Dysphagia 2.4 (1988): 216-219.
Schatz, Kenneth, Susan E. Langmore, and Nels Olson. "Endoscopic and videofluoroscopicevaluations of swallowing and aspiration." Annals of Otology, Rhinology & Laryngology100.8 (1991): 678-681.
Langmore, Susan E. "Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior?." Current opinion in otolaryngology & head and neck surgery 11.6 (2003): 485-489.
Link, Dana Thompson, et al. "Pediatric laryngopharyngeal sensory testing during flexible endoscopic evaluation of swallowing: feasible and correlative." Annals of Otology, Rhinology & Laryngology 109.10 (2000): 899-905.
Hartnick, Christopher J., et al. "Pediatric fiberoptic endoscopic evaluation of swallowing." Annals of Otology, Rhinology & Laryngology 109.11 (2000): 996-999.
Willging, J. Paul, and Dana M. Thompson. "Pediatric FEESST: fiberoptic endoscopic evaluation of swallowing with sensory testing." Current gastroenterology reports 7.3 (2005): 240-243.
da Silva, Andréa P., José F. Lubianca Neto, and Patrícia Paula Santoro. "Comparison between videofluoroscopy and endoscopic evaluation of swallowing for the diagnosis of dysphagia in children." Otolaryngology-Head and Neck Surgery 143.2 (2010): 204-209.
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REFERENCES Kelly AM, McLaughlin C, Wallace S, Hales P, Stewart C, Leathley C, Cunningham R.
Fibreoptic Endoscopic Evaluation of Swallowing (FEES): The role of speech and language therapy. Royal College of Speech and Language Therapists Position Paper, 2015 London.
Rommel N , De Meyer AM , Feenstra L , Veereman-Wauters G . Thecomplexity of feeding problems in 700 infants and young childrenpresenting to a tertiary care institution . J PediatrGastroenterol Nutr.2003 ; 37 ( 1 ): 75-84 .
Hamilton BE , Martin JA , Osterman MJK , Curtin SC . Births: preliminarydata for 2013 . NatlVital Stat Rep. 2014 ; 63 ( 2 ):2.
Lefton-Greif MA. 2008. Pediatric dysphagia. Phys. Med Rehabil. ClinN Am 19 (4): 837-51, ix.
Berlin, C. M., et al. "''Inactive''ingredients in pharmaceutical products: Update (subject review)." Pediatrics 99.2 (1997): 268-278.
Lefton-Greif MA, Carroll JL, and Loughlin GM. 2006. Long-term follow-up of oropharyngealdysphagia in children without apparent risk factors. Pediatr. Pulmonol. 41 (11): 1040-1048.
http://linkstudio.info/portfolio/pediatric-swallowing/
Arvedson, Joan, et al. "Evidence-based systematic review: effects of oral motor interventions on feeding and swallowing in preterm infants." American Journal of speech-language pathology 19.4 (2010): 321-340.
http://www.karelsavry.us/guide_7/images/337_279_59-newborn-phases-swallowing
Manikam, Ramasamy, and Jay A. Perman. "Pediatric feeding disorders." Journal of clinical gastroenterology
REFERENCES Cichero, J. A., Nicholson, T. M., & September, C. (2013). Thickened Milk for the Management
of Feeding and Swallowing Issues in Infants A Call for Interdisciplinary Professional Guidelines. Journal of Human Lactation, 0890334413480561.
Dodrill, P., Donovan, T., Cleghorn, G., McMahon, S., & Davies, P. S. W. (2008). Attainment of early feeding milestones in preterm neonates. Journal of Perinatology, 28(8), 549-555.
Groher, M. E., & Crary, M. A. (2015). Dysphagia: clinical management in adults and children. Elsevier Health Sciences.
Steele, C. M., Alsanei, W. A., Ayanikalath, S., Barbon, C. E., Chen, J., Cichero, J. A., ... & Hanson, B. (2015). The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia, 30(1), 2-26.
Woods, C. W., Oliver, T., Lewis, K., & Yang, Q. (2012). Development of necrotizing enterocolitisin premature infants receiving thickened feeds using SimplyThick®. Journal of Perinatology, 32(2), 150-152.
Lauriello, N., Cammack, F. S., & Hanford, J. The Baby-Friendly Initiatives.
Jones, J. R., Kogan, M. D., Singh, G. K., Dee, D. L., & Grummer-Strawn, L. M. (2011). Factors associated with exclusive breastfeeding in the United States. Pediatrics, peds-2011.
Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827-e841.