NANT 10 4/24/2020

1

FEES EXPANSION TO NEW POPULATIONS:

WHAT’S IN THE EVIDENCE?NANT 10 Conference

Jenny Reynolds, MS CCC-SLP, CNT, CLC, BCS-S

DISCLOSURES

FINANCIAL

Salary from Baylor Scott and White Institute for Rehabilitation

NON-FINANCIAL

Member of NANT National Professional Collaborative

FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING

NANT 10 4/24/2020

2

HISTORY OF FEESFEES

Adult

Langmore, Schatz, Olsen(1988,1991)

Bastian

(1991, 1993)

Langmore(2001)

Pediatric

Willging

(1995, 2000)

Willging, Miller, Hogan, Rudolph

(1996)

Hartnick, Miller, Willging(2000)

The study can be performed safely in children as young as premature infants & in adults. (Willging & Thompson, 2005)

Hartnick, Hartley, Miller, & Willging (2000) • 643 FEES on 568 patients• 3 days to 21 years (M=2.5 years)

Leder & Karas (2000) • 30 patients• 11 days to 20 years (M=10.3 yrs)

da Silva, Lubianca Neto, & Santoro (2010) • 30 patients• 10.5 mos to 37.3 mos (M=25.8 mos)

Leder, Baker, & Goodman (2010) • 14 patients• 3 mos to 14 mos (M=8.5 mos)

Sitton, et al. (2011) • 79 patients• 12 days to 170 mos (M=26 mos)

Beer, Hartlieb, Müller, Granel, & Staudt (2014)

• 30 patients• 10 mos to 17 years (M=5 years)

Ahmed-Abdelhamid & Sarwat (2016) • 64 patients/controls• 2 mos to 168 mos (M=41-49 mos)

FEES SAFETY: PEDIATRICS & INFANTS

INTER-RATER RELIABILITY VFSS FEESPENETRATION ASPIRATION PENETRATION ASPIRATION

Leder & Karas (2000)• 30 children• 7 had both VFSS & FEES

100% 100% 100% 100%

da Silva, Lubianca Neto, & Santoro (2010)• 30 children• 2 reviewers

n/a n/a 87% 90%

PEDIATRIC VFSS & FEES

COMPARATIVE EFFECTIVENESS (not completed simultaneously)

PENETRATION ASPIRATION

Leder & Karas (2000)• 7 children

100% 100%

da Silva, Lubianca Neto, & Santoro (2010)• 30 children• 2 reviewers

53% / 60% 53% / 50%

NANT 10 4/24/2020

3

Willette, Molinaro, Thompson, & Schroeder (2015)

• 26 FEES exams on 23 breastfeeding infants• 13 days to 10 months

• No major complications• No significant oxygen desaturation• No respiratory or cardiac distress, cyanosis, or need for additional support• No epistaxis that required intervention

“FEES is safe, well tolerated, & easy to perform…for infants”

FEES WITH BREASTFEEDING INFANTS

FEES IN THE NICU

Determining the efficacy of

using FEES compared to

VFSS to diagnose laryngeal

penetration & aspiration in

infants in the NICU

Suterwala, Reynolds, Carroll, Sturdivant, Armstrong 2017Journal of Perinatology

“Fiberoptic Endoscopic Evaluation of Swallowing to detect laryngeal penetration and aspiration in infants in the neonatal care unit”

Can FEES assess swallowingduring breastfeeding?

How does FEES compare to the VFSS with infants?

Is FEES safe, reliable, & effective with infants in the NICU?

SUTERWALA, et al 2017

NANT 10 4/24/2020

4

STUDY PARTICIPANTS

• Inpatient in BUMC NICU• Mean gestational age: 39.9 weeks (range 37-49 wks)• 10 males; 15 females

25 INFANTS25 INFANTS

• Bedside clinical exam suggested aspiration• Able to undergo both FEES & VFSS• No bilateral complete cleft lip & palate

CRITERIACRITERIA

• IRB approved• Parental informed consent obtained

IRBIRB

SUTERWALA, et al 2017

CHARACTERISTIC N (%)

Patent ductus arteriosus - ligation 4 (16%)

Intraventricular hemorrhage 8 (32%)

Surgical necrotizing enterocolitis 1 (4%)

Respiratory distress syndrome 19 (76%)

Gastroesophageal reflux disease 4 (16%)

Nasogastric tube 22 (88%)

Oxygen nasal cannula 16 (64%)

MEDICAL CHARACTERISTICS

SUTERWALA, et al 2017

STUDY DESIGNVFSS or FEESVFSS or FEES

VFSS or FEESVFSS or FEES

Breastfeeding FEES

Breastfeeding FEES

SUTERWALA, et al 2017

NANT 10 4/24/2020

5

STUDY DESIGN

on penetration/aspiration findings

BEFORE VFSS & FEES

• Vital signs within 10 minutes

before scoping & within 5 minutes

after feeding

• Standard protocol varying the

nipple type & consistency based

on penetration/aspiration findings

AFTER VFSS & FEES

• Two SLPs reviewed recordings &

documented

penetration/aspiration (blinded)

• Reached consensus for

FEES/VFSS comparison

SUTERWALA, et al 2017

RESULTS: SAFETY

No adverse events or major

complications during the study (e.g., epistaxis or

laryngospasm)

No adverse events or major

complications during the study (e.g., epistaxis or

laryngospasm)

No infant demonstrated any major instance of

autonomic instability

No infant demonstrated any major instance of

autonomic instability

SUTERWALA, et al 2017

RESULTS: SAFETYPre-Feeding Post-Feeding p-value

Respiratory Rate

Mean ± std 52.7 ± 10.8 50.8 ± 18.9 0.6204

Range 31-78 21-107

Heart Rate (bpm)

Mean ± std 163 ± 14 168 ± 15 0.1100

Range 128-184 130-188

O2 Saturation (%)

Mean ± std 97.5 ± 2.6 95.1 ± 9.6 0.2207

Range 92-100 52-100

SUTERWALA, et al 2017

NANT 10 4/24/2020

6

RESULTS: INTER-RATER RELIABILITY

ASSESSMENT n PENETRATION ASPIRATION

VFSS 78 87% 90%

FEES 66 80% 80%

PENETRATION ASPIRATION

Presence Absence Presence Absence

VFSS 86% 88% 43% 94%

FEES 85% 72% 0% 89%

SUTERWALA, et al 2017

PENETRATION (56%) VFSS

FEES Yes No

Yes 13 (26%) 18 (36%)No 4 (8%) 15 (30%)

ASPIRATION (92%) VFSS

FEES Yes No

Yes 1 (2%) 1 (2%)No 3 (6%) 45 (90%)

RESULTS: AGREEMENT BETWEEN VFSS & FEES BY CONSISTENCY TRIAL (N=50)

ARMSTRONG, et al. 2019“Comparing Videofluoroscopy and endoscopy to assess swallowing in bottle-fed young infants in the NICU”Journal of Perinatology

FEES: INFANTS IN THE NICUVetter-Leracy et al (2018)

Aims of the Study:• Determine # of premature infants with desaturations during feeding due to aspiration using FEES• Relate clinical factors and FEES findings to aspiration• Describe type and efficiency of suggested treatments

Methods:• Retrospective review of 62 premature infants• Median PMA 40 weeks• Underwent FEES for persistent desaturation during feeding (after >36 weeks PMA)• Compared recordings of desaturations during feedings 7 days before and after the FEES

Results: • 44 of the infants (71%) - penetration and/or aspiration was identified.• No relation was found to demographic or clinical data• Accumulation of saliva and residues post swallowing were related to aspiration (P<0.01)• Use of a thickener reduced aspiration during FEES on 77% of the infants• 9.1% of infants required gastrostomy tube

NANT 10 4/24/2020

7

BREASTFEEDING FEES

Armstrong, Reynolds, Sturdivant, Carrroll, Suterwala 2019

• Purpose: Safety and feasibility of FEES in NICU infants during breastfeeding• 5 infants recruited• 37 weeks PMA or above

• Results:• Mean PMA of 39.8 weeks• No adverse events• No statistically significant differences between

pre-feeding & post-feeding vital signs• Human milk was observable during swallows• Penetration was identified in one infant• Further study is needed

“Assessing Swallowing of the Breastfeeding NICU Infant Using FEES: A Feasibility Study”

National Association of Neonatal Nursing

CLINICAL INDICATIONS FORINFANT FEES:

BOTTLE AND BREASTFEEDINGNANT 10 Conference

Jenny Reynolds, MS CCC-SLP, CNT, CLC, BCS-S

DEFINING NEONATAL & INFANT FEES

INFA

NT

FE

ES

INFA

NT

FE

ES

FUNCTIONALFUNCTIONAL

ENTIRE FEEDING IF TOLERATED/NEEDEDENTIRE FEEDING IF

TOLERATED/NEEDED

LIVE TIME INTERVENTIONS/STRATEGIES

LIVE TIME INTERVENTIONS/STRATEGIES

POSITIONINGPOSITIONING

EQUIPMENTEQUIPMENT

VISCOSITYVISCOSITY

FAMILY CENTEREDFAMILY CENTERED

INCREASE COMPETENCE & CONFIDENCE

INCREASE COMPETENCE & CONFIDENCE

LIVE TIME

EDUCATION & FEEDBACK

LIVE TIME

EDUCATION & FEEDBACK

NANT 10 4/24/2020

8

NEONATAL & INFANT FEES

ADVANTAGES No barium

No radiation

Bedside evaluation

HD view of structures

No time constraints

Family centered

Cost effective

Real-time evaluation of interventions

Simulates true feeding environment

Safe evaluation of bottle feeding & breastfeeding

DISADVANTAGES

Possible discomfort to patient

Specialized training needed

Unable to assess oral/esophageal phases of swallowing

Chain Swallows in infants can be difficult to interpret

White out during the swallow causing inability to view entire swallow sequence

Equipment cost

FEES IN INFANTS & CHILDREN: Protocol, Safety, Clinical Efficacy25 Years of ExperienceMiller & Willging 2019

Indications for Pediatric FEES

Readiness for oral feeding trials needs to be determined; patient is NPO or takes negligible oral intake

Suspected difficulty with oral secretion management

Known or suspected structural abnormality in the pharynx or larynx with possible impact on swallowing function

Abnormal videofluoroscopic swallowing study results; need more information about pharyngeal/laryngeal anatomy, function, and sensory threshold

Need to assess patient ability to achieve and sustain supraglottic and glottic closure; need to assess vocal fold mobility

Alternative to close interval videofluoroscopic examinations if appropriate, to avoid repeated radiation exposures

Contraindications for Pediatric FEES:

Complete choanal atresia, nasal obstruction

Significant pharyngeal stenosis precluding adequate view during FEES

Severe micrognathia and glossoptosis

Significant medical fragility

FEES IN INFANTS & CHILDREN: Protocol, Safety, Clinical Efficacy25 Years of ExperienceMiller & Willging 2019 DIAGNOSTIC CATEGORIES OF PATIENTS UNDERGOING PEDIATRIC FEES

STRUCTURALCraniofacial anomalies, syndromes with craniofacial component

Pharyngeal stenosisLaryngeal anomalies: laryngomalacia, vallecular cyst, vocal fold paralysis, laryngeal web, laryngeal

cleft, subglottic stenosisTracheoesophageal fistula/Esophageal Atresia status post repair

FUNCTIONAL DISORDERS OF THE ESOPHAGUSCaustic ingestion injuries

Cricopharyngeal DysfunctionCricopharyngeal Achalai

NEUROLOGIC ETIOLOGIESPrematurity and swallowing dysfunction

Periventricular leukomalaciaHypoxic Ischemic Encephalopathy (HIE)

Anoxic Encephalopathy (respiratory arrest, drowning)Cerebral Palsy: spastic, athetoid, ataxic, mixed types

Chiari malformation (Type I and Type II)Brain tumors: astrocytoma, brainstem glioma, ependymoma, germ cell tumor, medulloblastoma •• Leukodystrophy

Pediatric cerebrovascular accident (CVA)Abnormalities of the corpus collosum

Peripheral nerve diseases (muscular dystrophies, congenital myopathies, spinal muscular atrophy, infant botulism

NANT 10 4/24/2020

9

FEES IN INFANTS & CHILDREN: Protocol, Safety, Clinical Efficacy25 Years of ExperienceMiller & Willging 2019

DIAGNOSTIC CATEGORIES OF PATIENTS UNDERGOING PEDIATRIC FEES (continued)

CARDIORESPIRATORY CONDITIONSCongenital heart defects affecting coordination of respiration and swallowing: atrial septal

defect, aortic valve stenosis, atrioventricular canal defect, coarctation of the aorta, Ebstein anomaly, hypoplastic left heart syndrome, interrupted aortic arch, patent ductus arteriosus, pulmonary atresia,

pulmonary valvar stenosis, total anomalous pulmonary venous return, transposition of the great arteries, vascular rings, ventricular septal defects, Tetralogy of Fallot

Respiratory distress syndromeMeconium aspiration syndrome

Brief Resolved Unexplained Event in Infants (BRUE)Lower airway disorders: cystic fibrosis, bronchopulmonary dysplasia, pneumonia

METABOLIC DISORDERSUrea cycle defect/disorder

Hereditary fructose intoleranceLyosomal storage diseases

Metabolic myopathyGlycogen storage disease

Mitochondrial disorder

ASSOCIATIONS/SEQUENCES/SYNDROMESCHARGE SyndromeMoebius Syndrome

Smith-Lemli-Opitz SyndromeCornelia de Lange Syndrome

Noonan SyndromeCoffin Sirris SyndromeVACTERL Association

Trisomy 8, 9, 13, 18, 21, 22

BSWH NEONATAL & INFANT FEES CRITERIA

INDICATIONS CONTRAINDICATIONS

Age/Maturity (37 weeks +) and autonomically stable

Autonomic instability at rest

Signs/Symptoms of swallowing dysfunctionduring clinical feeding evaluation & treatment (bottle and/or breastfeeding)

Anatomic considerations:Nasal obstructionChoanal atresia

Stridor/Stertor Consider state regulation

Airway abnormality suspected

Difficulty weaning respiratory support

Assess readiness for oral feedings/secretion management

All compensatory strategies have been attempted (positioning, equipment- slow flow nipple, pacing, etc)

NEONATAL & INFANT FEES TEAM (varies per facility)

TEAM MEMBER ROLEENT • Endoscopist (dependent on facility)

• Reviews all exams after completed by/or with SLP

SLP • Endoscopist (dependent on facility)• Feeding therapist & interpretation of exam• Education to family/staff

NEONATAL FEEDING THERAPIST

• Feeding the infant during the exam• Providing calming strategies to infant• Education to family/staff

LACTATION CONSULTANT Assist mom/infant with positioning and latch in breastfeeding fees

RN Assess infant before, during and after procedure

NEONATOLOGIST Collaboration before, during & after procedure

DIETITIAN Discuss diet preparation before exam

NANT 10 4/24/2020

10

NEONATAL & INFANT FEES EQUIPMENT

PENTAX MEDICAL

Fiberscope

• 2.4mm• 3.5mm

Videoscope

• 2.4mm• 3.3mm • 3.7mm

OLYMPUS

Fiberscope

• 2.2mm • 3.4mm

Videoscope

• 2.6mm• 3.4mm

STORZ

Fiberscope

• 2.5mm• 2.8mm• 3.5mm

Videoscope

• 2.4 mm• 4mm

ENHACING VISUALIZATION DURING FEES

Enha

nce

Visu

aliz

atio

n

Food Grade DyeFood Grade Dye

AquadexAquadex

BetacarotineBetacarotine

Phagein BluePhagein Blue

TOPICAL ANESTHESIA: CAUTION

CONSIDERATIONS

Pain/comfort during endoscopy

Impact on swallowing function

TYPE APPLICATION

Local anesthetic• Spray• Topical gel applied with cotton

tip applicator

Nasal decongestant

• Spray

PUBLICATIONS

Use of topicalanesthesia

affect swallow function

• Bastian1999

• Hartnick 2000

• Johnson 2003

Topical anesthesia used for patient

comfort but not affect the

swallow

• Lester 2013

• Fife 2015• O’Dea

2015

Use of topical anesthesia does not increase

comfort and tolerance

• Frosh 1998• Leder et al

1997• Singh 1997

TALK TO YOUR PHYSICIAN &

TAKE CAUTION WITH INFANTS

NANT 10 4/24/2020

11

POSSIBLE COMPLICATIONS

EPISTAXIS

• Self-limiting• Apply Pressure• Cautious Entry

REACTION TO TOPICAL

ANESTHESIA

• Rare• Cautious use

with Infants• Can increase

heart rate/BP

VASOVAGAL RESPONSE

• Patient • Caregiver

LARYNGOSPASM

• Reflexive closure of the glottis

• Generally seen in anesthetized patients

• Low risk in awake state

Aviv, et al. 2000, Aviv, Kaplan & Langmore 2001

NEONATAL FEES PREPARATION

Identify and Plan for FEES

• Comprehensive feeding evaluation• Discuss with team

• Obtain MD order• Parental education

• Schedule• Team pre-huddle

• Prepare infant exam report form

NEONATAL FEES PREPARATION

TEAM HUDDLE FORM

Maternal history

Infant birth history

Infant co-morbidities

Environment

Neurobehavioral

Neuromotor

Sensory

Current diet/method of delivery

Feeding & swallowing evaluation & interventions

Indications for FEES

NANT 10 4/24/2020

12

NEONATAL FEES SET-UP

Nurse

Prepare the milk

Neonatal Feeding

Therapist

Prepare the infant

Prepare the family

Prepare the environment

Endoscopist

Prepare equipment

Prepare the family

FEES: DURING THE EXAM

Initial insertion of bottle & scope

• NNS and sucrose prior to exam• NT insertion of bottle

• Endoscopist insertion of scope• Anchor important

Begin Assessment

ASSESS NASOPHARYNX

Completed with ENT or reviewed by ENT

Nasopharynx

• Turbinates

• Appearance

• Velum

• Appearance

• Movement

App

eara

nce

Normal/abnormal

Inflammation

Blood

Secretions

Mov

emen

t

Lack of movement

Speed and range of movement

Symmetrical / Asymmetrical

NANT 10 4/24/2020

13

ASSESS APPEARANCE OF PHARYNX & LARYNX

Completed with ENT or FEES video

reviewed by ENT

• Posterior Pharyngeal Wall

• Base of Tongue

• Vallecula

• Epiglottis

• Vocal folds

• Aryepiglottic folds

• Arytenoids

• Pyriform sinus

App

eara

nce

Normal/abnormal

Symmetry

Inflammation/Edema

Erythema

Supraglottic collapse

Pachydermia

Post cricoid swelling

ASSESS MOVEMENT OF PHARYNX & LARYNXCompleted by ENT or

reviewed by ENT

• Pharyngeal Walls

• Epiglottis

• Vocal folds

• Arytenoids

Mov

emen

t

Normal

Lack of movement

Symmetrical / Asymmetrical

Speed and range of movement

ASSESS SECRETION MANAGEMENT

Se

cre

tion

ma

na

ge

me

nt

Describe appearance

(thick, thin)

Location

Amount

Response to secretions

Swallow frequency

NANT 10 4/24/2020

14

ASSESS SWALLOWING & STRATEGIES

Assessment with bolus presentations

Swallow response time

Airway protectionPenetration

Aspiration

Response

Residue Degree

Clearance

Response to therapeutic interventions to improve safety of swallow

Positioning

Equipment

Strategies

Viscosity Thickening agent if appropriate

Replicate typicalfeeding position

Try varying flow rates

Pacing

NEONATAL FEES: AFTER THE EXAM

Team Collaboration

• Support family and infant• Determine feeding plan• Follow up consultations

• Family Education• Cleaning scope/equipment

•Consultations (ENT, GI) •Family education•Cleaning scope

NANT 10 4/24/2020

15

FEES PROCEDURE: BREASTFEEDING

• Multidisciplinary team discussion prior to the procedure• Lactation- anticipatory guidance for mom; assist with positioning of

infant• Neonatal Therapist- assist with positioning of infant; dye

• ENT or SLP- Endoscopist

Verify team rolesVerify team roles

• Mix 2 drops of dye with 10 mL of EBM and deliver with 3 mL syringe• Swab tongue with dye• Paint breast with dye

• Small drops behind nipple shield

Options for visualizationOptions for visualization

• Begin with most practiced position that mom is most comfortable

Position for feeding & scopingPosition for feeding & scoping

• Positioning• Manual Compression

• Nipple shield

During the exam: Attempt StrategiesDuring the exam: Attempt Strategies

BREASTFEEDING FEES: POSITIONING OF ENDOSCOPIST

Position: Football

Endoscopist standing

Position: Football

Endoscopist kneeling

NANT 10 4/24/2020

16

BREASTFEEDING FEES:LESSONS LEARNED

• Team members roles: CLC/IBCLC involvement

• Anticipatory guidance/education to family

• Handling of scope by endoscopist

• Endoscopist comfort with breastfeeding

• Topical anesthesia on tip of scope (Willette)

INFANT FEES ONLINE SURVEY

Online IRB-approved survey of SLPs conducted in Summer 2018

Invitations to participate were e-mailed and posted to listservs

Participants were encouraged to forward the survey link to colleagues

Anonymous

33 SLPs responded

Presented at ASHA CONVENTION 2018

PRACTICE SETTINGS FOR INFANT FEES % SLPs who

perform infant FEES at each

setting

Average number infant FEES per week per SLP

Average number infant VFSS per week per SLP

Ratio VFSS to FEES

Children’s Hospital NICU 61% 0.97 1.75 1.8

Birthing/Delivery Hospital NICU 18% 0.91 0.94 1.0

Children’s Hospital ICU 48% 0.83 2.12 2.5

Children’s Hospital Non-ICU 55% 1.38 2.58 1.9

Pediatric Inpatient Rehab 24% 0.88 3.60 4.1

Outpatient Setting 58% 3.12 5.21 1.7

NANT 10 4/24/2020

17

RESULTS: TEAM AND PROCEDURE

Team

ENT passes the scope in most settings

SLP, ENT, Nurse, and Parent are generally present across most settings

Bottle-Feeding Procedure

Parents and other team members hold/feed the infant

Food grade dye most commonly used

Most use no anesthetic

97% reported using compensatory strategies

Breastfeeding

79% of SLPs reported using FEES to assess breastfeeding

RESULTS: ESTABLISHING COMPETENCIES Each facility has its own procedures for establishing

competencies

Variable specifics yet common components:

General knowledge of anatomy and physiology of the infant swallow

Educational didactic course (adult and/or pediatric)

Observation of infant fees

Hands-on training under a clinical mentor (SLP or ENT)

Passing the scope

Interpretation

Completing a set number of passes independently

BENEFITS OF FEES WITH INFANTS

Can complete a longer study and view/assess change over entire feeding and across feedings

View of anatomy

No radiation exposure (interim to avoid repeat VFSS; too many VFSS)

Positioning and strategies more easily attempted/more natural

Beneficial for trach/vent pts or those who have difficulty leaving the floor; easier/flexible scheduling

Breastfeeding

Can assess secretion management

No barium; can use breastmilk/actual milk

Increased interest by nursing staff who support the program

Good for presurgical exam

Ease of exam with parental paradigm remaining intact

Able to review images with family, medical staff, ent easily

Physicians appreciate being able to be present during study or view later

NANT 10 4/24/2020

18

CHALLENGES OF FEES WITH INFANTS

Calming the infant to latch; maintaining quiet alert state after passing scope and during bottle changes

White out with successive swallows; assumption of aspiration vs. direct observation

Harder to get longer studies with infants older than 3-6 months

Coordinating with ENT to obtain competency or to conduct study; variability of ENT practice/scope placement

Staff and physician acceptance; all agreeing on new feeding plan

Only assessing pharyngeal phase, not esophageal phase

Anatomical abnormalities

Positioning the scope/infant movement

Training can be challenging

Positioning the scope during breastfeeding

Highly sensitive preemie less likely to tolerate the scope

Difficult with nasal cannula/NGT

Inability to acquire highest quality equipment due to funding

“Thank you for the FEES. As a new, first-time mom, I am so grateful for all of the hard work & diligence that everyone at Baylor has put in to take the best

care of my son, Teddy. I especially appreciate everyone involved in the FEES.

I feel so much better knowing for sure how to safely feed my son.”

WHY IT MATTERS…

BSWH NEONATAL FEES PROGRAM

• Transfer to Children’s hospital for further aerodigestive evaluation

• Surgery

• Determining safe and most effective feeding plan

• Understanding more about their infant’s swallow function

• Utilizing techniques for feeding and swallowing

• Breastfeeding• Bottle feeding

Parent Confidence

Parent Competence

Rapid ReferralLength of Stay

305 Bottle feeding FEES procedures in NICU

26 Breastfeeding procedures in NICU

Collecting data and entering into database for analysis

BSWH Infant FEES in the NICU 2013-2020

NANT 10 4/24/2020

19

FUTURE DIRECTIONS FOR INFANT FEES

More research is needed on the infant population (under 12 months)

Safety

Reliability/validity

Use with breastfeeding

Work toward establishing common guidelines for training and competency

Work toward developing common procedures for infant FEES assessments

THANK YOU! Jenny.Reynolds@bswhealth.org

REFERENCES Langmore, Susan E., Schatz MA Kenneth, and Nels Olsen. "Fiberoptic endoscopic

examination of swallowing safety: a new procedure." Dysphagia 2.4 (1988): 216-219.

Schatz, Kenneth, Susan E. Langmore, and Nels Olson. "Endoscopic and videofluoroscopicevaluations of swallowing and aspiration." Annals of Otology, Rhinology & Laryngology100.8 (1991): 678-681.

Langmore, Susan E. "Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior?." Current opinion in otolaryngology & head and neck surgery 11.6 (2003): 485-489.

Link, Dana Thompson, et al. "Pediatric laryngopharyngeal sensory testing during flexible endoscopic evaluation of swallowing: feasible and correlative." Annals of Otology, Rhinology & Laryngology 109.10 (2000): 899-905.

Hartnick, Christopher J., et al. "Pediatric fiberoptic endoscopic evaluation of swallowing." Annals of Otology, Rhinology & Laryngology 109.11 (2000): 996-999.

Willging, J. Paul, and Dana M. Thompson. "Pediatric FEESST: fiberoptic endoscopic evaluation of swallowing with sensory testing." Current gastroenterology reports 7.3 (2005): 240-243.

da Silva, Andréa P., José F. Lubianca Neto, and Patrícia Paula Santoro. "Comparison between videofluoroscopy and endoscopic evaluation of swallowing for the diagnosis of dysphagia in children." Otolaryngology-Head and Neck Surgery 143.2 (2010): 204-209.

NANT 10 4/24/2020

20

REFERENCES Kelly AM, McLaughlin C, Wallace S, Hales P, Stewart C, Leathley C, Cunningham R.

Fibreoptic Endoscopic Evaluation of Swallowing (FEES): The role of speech and language therapy. Royal College of Speech and Language Therapists Position Paper, 2015 London.

Rommel N , De Meyer AM , Feenstra L , Veereman-Wauters G . Thecomplexity of feeding problems in 700 infants and young childrenpresenting to a tertiary care institution . J PediatrGastroenterol Nutr.2003 ; 37 ( 1 ): 75-84 .

Hamilton BE , Martin JA , Osterman MJK , Curtin SC . Births: preliminarydata for 2013 . NatlVital Stat Rep. 2014 ; 63 ( 2 ):2.

Lefton-Greif MA. 2008. Pediatric dysphagia. Phys. Med Rehabil. ClinN Am 19 (4): 837-51, ix.

Berlin, C. M., et al. "''Inactive''ingredients in pharmaceutical products: Update (subject review)." Pediatrics 99.2 (1997): 268-278.

Lefton-Greif MA, Carroll JL, and Loughlin GM. 2006. Long-term follow-up of oropharyngealdysphagia in children without apparent risk factors. Pediatr. Pulmonol. 41 (11): 1040-1048.

http://linkstudio.info/portfolio/pediatric-swallowing/

Arvedson, Joan, et al. "Evidence-based systematic review: effects of oral motor interventions on feeding and swallowing in preterm infants." American Journal of speech-language pathology 19.4 (2010): 321-340.

http://www.karelsavry.us/guide_7/images/337_279_59-newborn-phases-swallowing

Manikam, Ramasamy, and Jay A. Perman. "Pediatric feeding disorders." Journal of clinical gastroenterology

REFERENCES Cichero, J. A., Nicholson, T. M., & September, C. (2013). Thickened Milk for the Management

of Feeding and Swallowing Issues in Infants A Call for Interdisciplinary Professional Guidelines. Journal of Human Lactation, 0890334413480561.

Dodrill, P., Donovan, T., Cleghorn, G., McMahon, S., & Davies, P. S. W. (2008). Attainment of early feeding milestones in preterm neonates. Journal of Perinatology, 28(8), 549-555.

Groher, M. E., & Crary, M. A. (2015). Dysphagia: clinical management in adults and children. Elsevier Health Sciences.

Steele, C. M., Alsanei, W. A., Ayanikalath, S., Barbon, C. E., Chen, J., Cichero, J. A., ... & Hanson, B. (2015). The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia, 30(1), 2-26.

Woods, C. W., Oliver, T., Lewis, K., & Yang, Q. (2012). Development of necrotizing enterocolitisin premature infants receiving thickened feeds using SimplyThick®. Journal of Perinatology, 32(2), 150-152.

Lauriello, N., Cammack, F. S., & Hanford, J. The Baby-Friendly Initiatives.

Jones, J. R., Kogan, M. D., Singh, G. K., Dee, D. L., & Grummer-Strawn, L. M. (2011). Factors associated with exclusive breastfeeding in the United States. Pediatrics, peds-2011.

Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827-e841.