767 - Risk factors associated with aspiration noted on fiberoptic endoscopic evaluation of swallowing in preterm infants

Preterm infants are at risk of aspiration during feeding due to oro-motor discoordination and swallowing dysfunction. Aspiration with feeds is reported be associated with aspiration contributing to a prolonged hospital stay or worsening respiratory morbidity. 

At our institution, Fiberoptic Endoscopic Evaluation of Swallowing (FEES) where a flexible endoscope is used to assess the physiology of the swallow mechanism in real-time, has been used as an instrumental assessment in the evaluation of swallowing dysfunction and aspiration. While FEES is commonly used in the pediatric and adult population, studies in the neonatal population are limited.

Objective:

To evaluate for clinical or demographic risk factors associated with the FEES finding of aspiration.

Design/Methods:

Retrospective chart review of 83 infants born in 2018-2022 and who received FEES evaluation. Infant characteristics, FEES findings and respiratory support were compared between infants with and without aspiration or penetration noted on FEES by bivariate analysis. Multinomial logistic regression was used to identify significant risk factors found significant on bivariate analysis. Two-tailed P value < 0.05 was considered significant. 

Results:

A total of 83 premature infants with mean birth gestational age of 32.1 weeks were included. 33 (39.8%) infants were reported to have aspiration below the vocal cords or penetration into laryngeal vestibule. Pharyngeal pooling and residue in hypopharynx were noted in 42(50.6%) and 15(18.15) infants respectively. There was no difference aspiration risk based on infant’s characteristics, respiratory support, or BPD grade on bivariate analysis. FEES finding of residue in the hypopharynx and pharyngeal pooling were higher in aspiration/penetration group (p< 0.01) (Table1). Multinomial logistic regression of associated FEES findings showed pharyngeal pooling (OR: 3.1, 95% CI 1.1-8.9, P=0.03) and laryngomalacia (OR: 3.4, 95% CI 1.2-10, p= 0.02) were associated with increased odds of aspiration/penetration (Table 2).

Conclusion(s):

Our study evaluating factors associated with aspiration or penetration noted on FEES showed no difference in infant’s characteristics or BPD diagnosis. However, findings of pharyngeal pooling and laryngomalacia on FEES were significantly associated with aspiration. Further larger studies are required to corroborate this finding.