Dysphagia

pp 1–9 | Cite as

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

  • Louisa Ferrara
  • Ranjith Kamity
  • Shahidul Islam
  • Irene Sher
  • Dan Barlev
  • Laurie Wennerholm
  • Fran Redstone
  • Nazeeh Hanna
Original Article

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.

Keywords

Deglutition Deglutition disorders Thermal stimulation Neonate Dysphagia Infant Fluoroscopy 

References

  1. 1.
    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.CrossRefGoogle Scholar
  2. 2.
    Boesch RP, Wood RE. Aspiration. Kendig and Chernick’s disorders of the respiratory track in children. 8th ed. Philadelphia: Elsevier; 2012. p. 947–8.CrossRefGoogle Scholar
  3. 3.
    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.CrossRefPubMedGoogle Scholar
  4. 4.
    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.
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    Tutor JD, Gosa MM. Dysphagia and aspiration in children. Pediatr Pulm. 2012;47(4):321–37.  https://doi.org/10.1002/ppul.21576.CrossRefGoogle Scholar
  7. 7.
    American Speech-Language Hearing Association Practice Portal (2017). Adult dysphagia. http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942550&section=Treatment.
  8. 8.
    Logemann JA. The dysphagia diagnostic procedure as a treatment efficacy trial. Clin Commun Disord. 1993;3(4):1–10.PubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 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.Google Scholar
  15. 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.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. 20.
    Teismann IK, Steinstrater O, Warnecke T, et al. Tactile thermal oral stimulation increases the cortical representation of swallowing. BMC Neurosci. 2009;10:71.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 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.Google Scholar
  24. 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.CrossRefGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 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.CrossRefPubMedGoogle Scholar
  27. 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.CrossRefGoogle Scholar
  28. 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.CrossRefPubMedGoogle Scholar
  29. 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.CrossRefPubMedGoogle Scholar
  30. 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.CrossRefPubMedGoogle Scholar
  31. 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.CrossRefPubMedGoogle Scholar
  32. 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.CrossRefGoogle Scholar
  33. 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.CrossRefPubMedGoogle Scholar
  34. 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.CrossRefPubMedGoogle Scholar
  35. 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.CrossRefPubMedGoogle Scholar
  36. 36.
    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 Hear Res. 1994;37(5):1041–59.CrossRefPubMedGoogle Scholar
  37. 37.
    Kidder TM. Dysphagia esophago/pharyngo/laryngeal interrelationships: airway. Dysphagia. 1995;10:228–31.  https://doi.org/10.1044/jshr.3705.1041.CrossRefPubMedGoogle Scholar
  38. 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.CrossRefPubMedGoogle Scholar
  39. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 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.CrossRefPubMedGoogle Scholar
  41. 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.CrossRefPubMedGoogle Scholar
  42. 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.CrossRefPubMedGoogle Scholar
  43. 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.CrossRefPubMedGoogle Scholar
  44. 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.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Louisa Ferrara
    • 1
  • Ranjith Kamity
    • 4
  • Shahidul Islam
    • 1
  • Irene Sher
    • 1
  • Dan Barlev
    • 1
  • Laurie Wennerholm
    • 2
  • Fran Redstone
    • 3
  • Nazeeh Hanna
    • 4
  1. 1.Children’s Medical CenterNYU-Winthrop HospitalMineolaUSA
  2. 2.White Plains HospitalWhite PlainsUSA
  3. 3.Adelphi UniversityGarden CityUSA
  4. 4.Division of Neonatology, Children’s Medical CenterNYU-Winthrop HospitalMineolaUSA

Personalised recommendations