Infant Aspiration and Risk of Lower Respiratory Complications on Clinical Feeding Evaluation

Introduction: Lower respiratory infections (LRIs) are a feared complication of infant aspiration. Modified barium swallow (MBS) study is considered the gold-standard to evaluate infant swallow. Repeat MBS studies place infants at risk of cumulative radiation exposure and increase hospital cost and resource utilization. Our group has previously shown that clinical feeding evaluation (CFE) is highly sensitive for infant aspiration and correlates closely with MBS. Here, we build on these data by examining the risk of lower respiratory complications.

Methods: A retrospective chart review of preterm and term infants at a tertiary children’s hospital who underwent CFE and MBS at < 51-weeks post-menstrual age (PMA) was conducted. LRIs at 12 months post-evaluation were recorded.

Results: A total of 36 patients were included (mean PMA 42 ± 2.4 weeks). All MBS studies were done < 7 days following CFE. Twenty-four patients had silent and 6 had overt aspiration on MBS. Notable signs on CFE were pulling away (36.1%), stridor (27.8%), shutting down (27.8%), and cough (25%). Sensitivity and specificity of CFE to predict aspiration on MBS were 100% and 30%, respectively. Two patients experienced aspiration-related (5.6%) and four experienced non aspiration-related (11.1%) LRIs at 12 months chronological age. Of those with aspiration-related LRIs, initial dietary modifications according to CFE supported those of the subsequent MBS. On multivariable logistic regression, neither silent or overt aspiration on MBS or CFE predicted aspiration-related or non aspiration-related LRIs when controlling for gestational age.

Conclusions: The rate of aspiration-related LRI was low in our cohort. Dietary modifications in patients with aspiration-related LRIs based on CFE did not differ from MBS. These data suggest that CFE has the potential to supplant MBS in select infants, mitigating radiation exposure and enhancing cost-effectiveness. Prospective trials are needed to assess aspiration and LRIs in patients diagnosed and monitored with CFE versus MBS. This may lead to a paradigm change in best practice algorithms for infants at risk of aspiration.