Top

Published in:

01-10-2018 | Original Article

Short-Term Effects of Cold Liquids on the Pharyngeal Swallow in Preterm Infants with Dysphagia: A Pilot Study

Authors: Louisa Ferrara, Ranjith Kamity, Shahidul Islam, Irene Sher, Dan Barlev, Laurie Wennerholm, Fran Redstone, Nazeeh Hanna

Published in: Dysphagia | Issue 5/2018

Abstract

Cold stimulation reduces airway compromise in adults with dysphagia. However, there is no sufficient evidence to support its use in the pediatric population. The primary goal of this pilot study is to assess the effect of cold liquid on the pharyngeal swallow mechanism in preterm infants with dysphagia. We hypothesized that thermal stimulation from cold liquid will decrease the risk of airway compromise in dysphagic preterm infants. Nine preterm infants with clinical symptoms of dysphagia were included. Video fluoroscopic swallow studies were used to assess the swallowing mechanism of each participant. The occurrence of swallow dysfunctions under room temperature liquid swallows (RTS) vs. short period cold liquid swallows (CS) was compared. Paired t test was used to test significance. The occurrence of deep penetration (p = 0.007) and aspiration (p = 0.002) decreased significantly in the CS condition compared with the RTS condition. There was a trend of less nasopharyngeal reflux with CS but did not reach statistical significance (p = 0.084). No differences were noted for mild penetration (p = 0.824). CS reduced airway compromise in dysphagic preterm infants compared to RTS. These data provide important information regarding the immediate effects of CS on pharyngeal swallowing in preterm infants with dysphagia. However, further investigation regarding its sustained effects is required before introducing to clinical practice.

Newman LA, Keckley C, Petersen MC, Hamner A. Swallowing function and medical diagnoses in infants suspected of Dysphagia. Pediatrics. 2001;108:1–4. https://doi.org/10.1542/peds.108.6.e106.CrossRef

Boesch RP, Wood RE. Aspiration. Kendig and Chernick’s disorders of the respiratory track in children. 8th ed. Philadelphia: Elsevier; 2012. p. 947–8.CrossRef

Taniguchi M, Moyer R. Assessment of risk factors for pneumonia in dysphagia children: Significance of video-fluoroscopic swallowing evaluation. Dev Med Child Neurol. 1994;36:495–502.CrossRefPubMed

Orenstein SR (2006) Oral, pharyngeal, and esophageal motor disorders in infants and children. GI Motility Online. https://doi.org/10.1038/gimo38. Available at: http://www.nature.com/gimo/contents/pt1/full/gimo38.html.

Smith CH, Logemann JA, Colangelo LA, Rademaker AW, Pauloski BR. Incidence and patient characteristics associated with silent aspiration in the acute care setting. Dysphagia. 1999;14:1–7. https://doi.org/10.1007/PL00009579.CrossRefPubMed

Tutor JD, Gosa MM. Dysphagia and aspiration in children. Pediatr Pulm. 2012;47(4):321–37. https://doi.org/10.1002/ppul.21576.CrossRef

American Speech-Language Hearing Association Practice Portal (2017). Adult dysphagia. http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942550&section=Treatment.

Logemann JA. The dysphagia diagnostic procedure as a treatment efficacy trial. Clin Commun Disord. 1993;3(4):1–10.PubMed

Ruark JL, McCullough GH, Peters RL, Moore CA. Bolus consistency and swallowing in children and adults. Dysphagia. 2002;17(1):24–33. https://doi.org/10.1007/s00455-001-0098-0.CrossRefPubMed

10.

Khoshoo V, Ross G, Kelly B, Edell D, Brown S. Benefits of thickened feeds in previously healthy infants with respiratory syncytial viral bronchiolitis. Pediatr Pulmonol. 2001;31:301–2.CrossRefPubMed

11.

Kuhlemeier KV, Palmer JB, Rosenberg D. Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia. 2001;16(2):119–22. https://doi.org/10.1007/s004550011003.CrossRefPubMed

12.

Cichero J, Nicholson TM, September C. Thickened milk for the management of feeding and swallowing issues in infants: a call for interdisciplinary professional guidelines. J Hum Lact. 2013;29(2):132–5. https://doi.org/10.1177/0890334413480561.CrossRefPubMed

13.

Almeida MB, Almeida JA, Moreira ME, Novak FR. Adequacy of human milk viscosity to respond to infants with dysphagia: experimental study. J Appl Oral Sci. 2011;19(6):554–9. https://doi.org/10.1590/S1678-77572011000600003.CrossRefPubMedPubMedCentral

14.

Dantas RO, Kern MK, Massey BT, et al. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol. 1990;258:675–81.

15.

Ebihara S, Kohzuki M, Sumi Y, Ebihara T. Sensory stimulation to improve swallowing reflex and prevent aspiration pneumonia in elderly dysphagic people. J Pharmacol Sci. 2011;115(2):99–104. https://doi.org/10.1254/jphs.10R05CP.CrossRefPubMed

16.

Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Lang Hear Res. 1994;37(5):1041–59. https://doi.org/10.1044/jshr.3705.1041.CrossRef

17.

Krival K. Clinical consideration of oral and related sensory processing and dysphagia. Perspect Swallowing Swallowing Disord. 2013;22(3):94–106. https://doi.org/10.1044/sasd22.3.94.CrossRef

18.

Cola PC, Gatto AR, Silva RG, Spadotto AA, Schelp AO, Henry MA. The influence of sour taste and cold temperature in pharyngeal transit duration in patients with stroke. Arq Gastroenterol. 2010;47(1):18–21. https://doi.org/10.1590/S0004-2803201000010000.CrossRefPubMed

19.

Seluk B, Uysal H, Aydogdu I, Akyuz M, Ertekin C. Effect of temperature on electrophysiological parameters of swallowing. J Rehabil Res Dev. 2007;44(3):373–80. https://doi.org/10.1682/JRRD.2006.08.0089.CrossRef

20.

Teismann IK, Steinstrater O, Warnecke T, et al. Tactile thermal oral stimulation increases the cortical representation of swallowing. BMC Neurosci. 2009;10:71.CrossRefPubMedPubMedCentral

21.

Holt LE, Davies EA, Hassel Meyer EG, Adams AO. A study of premature infants fed cold formula. J Pediatr. 1962;61:556–61. https://doi.org/10.1186/1471-2202-10-71.CrossRefPubMed

22.

Blumenthal I, Lealman GT, Shoesmith DR. Effect of feed temperature and phototherapy on gastric emptying in the neonate. Arch Dis Child. 1980;55(7):562–4.CrossRefPubMedPubMedCentral

23.

Gonzales I, Duryea EJ, Vasquez E, Geraghty N. Effect of enteral feeding temperature on feeding tolerance in preterm infants. Neonatol Net. 1995;14(3):39–43.

24.

Anderson CA, Berseth CL. Neither motor responses nor gastric emptying vary in response to formula temperature in preterm infants. Biol Neonatol. 1996;70(5):265–70.CrossRef

25.

Ferrara L, Bidiwalla A, Sher I, et al. Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates. J Perinatol. 2017;37(4):398–403. https://doi.org/10.1038/jp.2016.229.CrossRefPubMed

26.

Fink TA, Ross JB. Are we testing a true thin liquid? Dysphagia. 2009;24(3):285–9. https://doi.org/10.1007/s00455-008-9203-y.CrossRefPubMed

27.

McCallum S. Addressing nutrient density in the context of the use of thickened liquids in dysphagia treatment. ICAN Infant Child Adolesc Nutr. 2011;3(6):351–60. https://doi.org/10.1177/1941406411427442.CrossRef

28.

Woods CW, Oliver T, Lewis K, Yang Q. Development of necrotizing enterocolitis in premature infants receiving thickened feeds using Simply Thick^®. J Perinatol. 2012;32(2):150–2. https://doi.org/10.1038/jp.2011.105.CrossRefPubMed

29.

Meunier L, Garthoff JA, Schaafsma A, et al. Locust bean gum safety in neonates and young infants: an integrated review of the toxicological database and clinical evidence. Regul Toxicol Pharmacol. 2014;70(1):155–69. https://doi.org/10.1016/j.yrtph.2014.06.023.CrossRefPubMed

30.

Beal J, Silverman B, Bellant J, Young TE, Klontz K. Late onset necrotizing enterocolitis in infants following use of a xanthan gum-containing thickening agent. J Pediatr. 2012;161(2):354–6. https://doi.org/10.1016/j.jpeds.2012.03.054.CrossRefPubMed

31.

Miyazawa R, Tomomasa T, Kaneko H, Morikawa A. Effect of formula thickened with locust bean gum on gastric emptying in infants. J Paediatr Child Health. 2006;42(12):808–12. https://doi.org/10.1111/j.1440-1754.2006.00982.x.CrossRefPubMed

32.

Bosscher D, Van Caillie-Bertrand M, Van Dyck K, Robberrecht H, Van Cauwenbergh R, Deelstra H. Thickening infant formula with digestible and indigestible carbohydrate: availability of calcium, iron, and zinc in vitro. J Pediatr Gastroenterol Nut. 2000;30(4):373–8.CrossRef

33.

González-Bermúdez CA, Frontela-Saseta C, López-Nicolás R, Ros-Berruezo G, Martínez-Graciá C. Effect of adding different thickening agents on the viscosity properties and in vitro mineral availability of infant formula. Food Chem. 2014;159:5–11. https://doi.org/10.1016/j.foodchem.2014.02.168.CrossRefPubMed

34.

September C, Nicholson TM, Cichero JA. Implications of changing the amount of thickener in thickened infant formula for infants with dysphagia. Dysphagia. 2014;29(4):432–7. https://doi.org/10.1007/s00455-014-9523-z.CrossRefPubMed

35.

Stuart S, Motz JM. Viscosity in infant dysphagia management: comparison of viscosity of thickened liquids used in assessment and thickened liquids used in treatment. Dysphagia. 2009;24(4):412–22. https://doi.org/10.1007/s00455-009-9219-y.CrossRefPubMed

36.

37.

Kidder TM. Dysphagia esophago/pharyngo/laryngeal interrelationships: airway. Dysphagia. 1995;10:228–31. https://doi.org/10.1044/jshr.3705.1041.CrossRefPubMed

38.

Hamdy S, Jilani S, Price V, Parker C, Hall N, Power M. Modulation of human swallowing behaviour by thermal and chemical stimulation in health and after brain injury. Neurogastroenterol Motil. 2003;15:69–77.CrossRefPubMed

39.

Steele CM, Miller AJ. Sensory input pathways and mechanisms in swallowing: a review. Dysphagia. 2010;25(4):323–33. https://doi.org/10.1007/s00455-010-9301-5.CrossRefPubMedPubMedCentral

40.

Miller AJ. Oral and pharyngeal reflexes in the mammalian nervous system: their diverse range in complexity and the pivotal role of the tongue. Crit Rev Oral Biol Med. 2002;13(5):409–25. https://doi.org/10.1177/154411130201300505.CrossRefPubMed

41.

Barlow SM, Estep M. Central pattern generation and the motor infrastructure for suck, respiration, and speech. J Commun Disord. 2006;39(5):366–80. https://doi.org/10.1016/j.jcomdis.2006.06.011.CrossRefPubMed

42.

Lee JH, Chang YS, Yoo HS, et al. Swallowing dysfunction in very low birth weight infants with oral feeding desaturation. World J Pediatr. 2011;7(4):337–43. https://doi.org/10.1007/s12519-011-0281-9.CrossRefPubMed

43.

Mercado-Deane MG, Burton EM, Harlow SA, et al. Swallowing dysfunction in infants less than 1 year of age. Pediatr Radiol. 2001;31:423–8. https://doi.org/10.1007/s002470100456.CrossRefPubMed

44.

Steele CM, Molfenter SM, Péladeau-Pigeon M, Stokely S. Challenges in preparing contrast media for videofluoroscopy. Dysphagia. 2013;28(3):464–7. https://doi.org/10.1007/s00455-013-9476-7.CrossRefPubMedPubMedCentral

Title: Short-Term Effects of Cold Liquids on the Pharyngeal Swallow in Preterm Infants with Dysphagia: A Pilot Study
Authors: Louisa Ferrara
Ranjith Kamity
Shahidul Islam
Irene Sher
Dan Barlev
Laurie Wennerholm
Fran Redstone
Nazeeh Hanna
Publication date: 01-10-2018
Publisher: Springer US
Published in: Dysphagia / Issue 5/2018
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-018-9877-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Short-Term Effects of Cold Liquids on the Pharyngeal Swallow in Preterm Infants with Dysphagia: A Pilot Study

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2018

Factors Contributing to Hydration, Fluid Intake and Health Status of Inpatients With and Without Dysphagia Post Stroke

An Unusual Case of Heartburn and Esophageal Stenosis

Superior and Anterior Hyoid Displacement During Swallowing in Non-Dysphagic Individuals

Longitudinal Evaluation of Swallowing with Videofluoroscopy in Patients with Locally Advanced Head and Neck Cancer After Chemoradiation

Neural Mechanisms of Swallowing Dysfunction and Apraxia of Speech in Acute Stroke

The Importance of Considering Anatomical Variables in High-Resolution Manometry Measurements