Jennifer P Lundine1,2, Robert Dempster3,4, Kirby Carpenito5, Holly Miller-Tate5, Wendelin Burdo-Hartman4,6, Elizabeth Halpin2, Omar Khalid4,5. 1. Department of Speech & Hearing Science, The Ohio State University, Columbus, Ohio. 2. Division of Clinical Therapies, Nationwide Children, s Hospital, Columbus, Ohio. 3. Department of Psychology & Neuropsychology, Nationwide Children, s Hospital, Columbus, Ohio. 4. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio. 5. The Heart Center, Nationwide Children, s Hospital, Columbus, Ohio. 6. Division of Complex Care, Nationwide Children, s Hospital, Columbus, Ohio.
Abstract
BACKGROUND: Swallowing dysfunction is a known complication for infants with complex congenital heart disease (CHD), but few studies have examined swallowing outcomes following the hybrid procedure for stage 1 palliation in children with single ventricle physiology. OBJECTIVES: (1) Identify the incidence of aspiration in all infants with single ventricle physiology who underwent the hybrid procedure and (2) Compare results of clinical bedside and instrumental swallowing evaluations to examine the predictive value of a less invasive swallowing assessment for this population of high-risk infants. METHODS: This was a retrospective cohort chart review study. All patients with single-ventricle physiology who underwent the hybrid procedure received a referral for subsequent instrumental swallow assessment during a 4-year period. Results from clinical bedside evaluations were compared to those of the instrumental assessment. RESULTS: Fifty infants were included in this study. During instrumental swallow assessment, aspiration was observed in 28% of infants following the hybrid procedure. Normal swallowing function was identified in 44% of infants, and 28% demonstrated laryngeal penetration. Neither length of intubation nor prematurity were found to be predictors of aspiration. Thirty-six of these infants were assessed via clinical bedside evaluation prior to the instrumental evaluation. The sensitivity of the clinical bedside evaluation was 0.73 and the specificity was 0.92. CONCLUSIONS: This study reports on a cohort of infants with single ventricle physiology following the hybrid procedure and found the incidence of aspiration to be lower than previously reported. Improved clinical bedside evaluation guidelines are needed so that clinicians can predict more reliably which infants are at risk for aspiration following the hybrid procedure.
BACKGROUND:Swallowing dysfunction is a known complication for infants with complex congenital heart disease (CHD), but few studies have examined swallowing outcomes following the hybrid procedure for stage 1 palliation in children with single ventricle physiology. OBJECTIVES: (1) Identify the incidence of aspiration in all infants with single ventricle physiology who underwent the hybrid procedure and (2) Compare results of clinical bedside and instrumental swallowing evaluations to examine the predictive value of a less invasive swallowing assessment for this population of high-risk infants. METHODS: This was a retrospective cohort chart review study. All patients with single-ventricle physiology who underwent the hybrid procedure received a referral for subsequent instrumental swallow assessment during a 4-year period. Results from clinical bedside evaluations were compared to those of the instrumental assessment. RESULTS: Fifty infants were included in this study. During instrumental swallow assessment, aspiration was observed in 28% of infants following the hybrid procedure. Normal swallowing function was identified in 44% of infants, and 28% demonstrated laryngeal penetration. Neither length of intubation nor prematurity were found to be predictors of aspiration. Thirty-six of these infants were assessed via clinical bedside evaluation prior to the instrumental evaluation. The sensitivity of the clinical bedside evaluation was 0.73 and the specificity was 0.92. CONCLUSIONS: This study reports on a cohort of infants with single ventricle physiology following the hybrid procedure and found the incidence of aspiration to be lower than previously reported. Improved clinical bedside evaluation guidelines are needed so that clinicians can predict more reliably which infants are at risk for aspiration following the hybrid procedure.