120 - taVNS-Paired Feeding May Improve Swallow Coordination In Infants With Oromotor Dysfunction And Enhance White Matter Tract Integrity

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 120
Publication Number: 120.337

Anne R. Cribb, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Hunter Moss, Medical University of South Carolina, Charleston, SC, United States; Heather McGhee, Medical University of South Carolina, Charleston, SC, United States; Keeley McKelvey. Nichols, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Heather Bonilha, Emory University, Atlanta, GA, United States; Jens Jensen, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Alyssa Brennan, MUSC Children's Hospital, Mount Pleasant, SC, United States; Bashar Badran, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Mark S. George, Medical University of South Carolina College of Medicine, Sullivans Island, SC, United States; Dorothea Jenkins, Medical University of South Carolina College of Medicine, Charleston, SC, United States

Presenting Author(s)

SG

Sandra S. Garner, PharmD (she/her/hers)

Professor
Medical University of South Carolina College of Pharmacy
Charleston, South Carolina, United States

Co-Author(s)

Dorothea Jenkins, MD (she/her/hers)

Professor of Pediatrics
Medical University of South Carolina College of Medicine
Charleston, South Carolina, United States

Background: Neonates born prematurely or with brain injury often present with oral feeding impairments that extend hospitalization and may lead to placement of a gastrostomy tube. Pairing transcutaneous auricular vagus nerve stimulation (taVNS) with bottle feeding for 2-3 weeks in these infants who fail to meet oral feeding requirements improved feeding outcomes and may induce neuroplastic changes in major white matter (WM) tracts.

Objective:

To assess overall swallow function before and after a course of taVNS treatment and to determine if WM tract neuroplastic changes, indirectly assessed with kurtosis fractional anisotropy (KFA) of diffusional kurtosis imaging (DKI), correlate with Penetration-Aspiration Scale scores on videofluoroscopic swallow studies (VFSS).

Design/Methods: We performed VFSS and DKI on 3T Siemens Skyra MRI in 7 infants failing oral feeding before and after a two week course of taVNS treatment, with parental consent in an IRB-approved open-label trial (NCT 04643808). Two speech language pathologists blinded to taVNS condition (on or off) scored 10 swallows in each of 3 conditions (thin feeds with slow and fast nipple, thickened feeds). We processed DKI data using the PyDesigner pipeline for kurtosis parameter calculations. Related changes in Penetration-Aspiration Scale (PAS) score and DKI metrics were assessed with Pearson correlation coefficients.

Results: On average, there were slight improvements in PAS scores from before to after taVNS-paired feeding (n=7, mean change(SD) = -0.24± 0.98), with lower PAS scores reflecting better swallow function. In infants with PAS improvements after treatment, the changes were associated with increased KFA in right external capsule (EC, r -0.81, p=0.049, n=6). After treatment, better PAS scores were associated with increased KFA in right EC (r=-0.85, p=0.014, n=7), left cerebellar peduncle (r=-0.83, p=0.020, n=7), and right (r=-0.84, p=0.037, n=6) and left superior longitudinal fasciculus (r=-0.83, p=0.042, n=6), which play roles in faciobrachial coordination and speech.

Conclusion(s): Better swallow function after a taVNS-paired feeding course is associated with greater increases in microstructural complexity, as inferred from DKI measures, of specific WM tracts involved in motor aspects of speech. In future trials, we will continue to study the impact of taVNS-paired feeding on swallow coordination in infants with oromotor dysfunction.