New strategy helps infants swallow on their own

By Megan Rauscher

NEW YORK (Reuters Health) - Some infants who have severe problems swallowing, a disorder called dysphagia, can learn to feed on their own, eliminating the need for long-term gastrostomy tubes, investigators report. The approach involves crib-side motion studies of the throat and esophagus, and individualized treatment by a multidisciplinary team of specialists.

In the study, published in the Journal of Pediatric Gastroenterology and Nutrition, 15 out of 20 infants with severe swallowing abnormalities, based on the results of videofluoroscopic tests, were able to feed on their own at discharge after using the strategy developed by clinicians in the Neonatal and Infant Feeding Disorders Program at Nationwide Children''s Hospital in Columbus, Ohio.

The strategy aims first to determine the underlying problem of each newborn''s feeding problems through studies of the throat and esophagus. The next step is feeding and directly observing what occurs as attempts at swallowing and breathing are made, lead author Dr. Sudarshan Jadcherla told Reuters Health.

The researchers placed a probe during feeding cycles to record signals for 3 hours of various neural reflexes involved with swallowing and feeding. The data were then shared with a multidisciplinary team that collaborated to develop an individualized feeding strategy.

Jadcherla said the study shows not having to always use a feeding tube is possible when motion studies guide the development of multidisciplinary feeding approaches. "The success rate in this study was 75 percent," Jadcherla noted. The five infants who were not able to eat normally after the intervention required chronic tube feeding.

Compared with the infants who were able to eat normally, infants in the feeding failure group had a markedly different sequence of motions when swallowing was attempted, characterized by the frequent swallows, failure to completely move food through the digestive system, less frequent responses to water swallows, poor responses to attempts at oral feeding, prolonged relaxation of the upper portion of the esophagus and other abnormalities.

Videofluoroscopic imaging study findings had little effect on the feeding outcomes, the researchers say, suggesting that manometry "may be a better predictor than videofluoroscopic studies in identifying infants who will probably be successful in this type of vigorous intervention program.

"This study," Jadcherla said, "has enormous cost savings to the patient and family in that it has been estimated that the health care cost for children on gastrostomy tubes is nearly $50,000 per patient for the first year, and up to $180,000 over a 5-year period per patient."

SOURCE: Journal of Pediatric Gastroenterology and Nutrition, February 2009.