Abstract:
Background: The prevalence of neonatal dysphagia is increasing, as medical
advances contribute to the survival of critically ill and preterm infants. Additional
factors such as low birth weight (LBW), gastroesoephageal reflux disorder (GERD),
failure to thrive (FTT) and exposure to HIV may increase the complexity of dysphagia
symptoms. Knowledge of context-specific risk factors for dysphagia in the neonatal
intensive care unit (NICU) may lead to an effective pathway of diagnosis and
management in vulnerable neonates.
Objective: The objective was to describe the feeding characteristics and categories
of underlying medical conditions in 24 to 42 week gestational age infants while still in
the NICU and who were referred for feeding and swallowing assessment.
Method: The study was a retrospective investigation of 231 purposively selected
medical and speech-language therapy records. Participants had a mean stay of 28.5
days in the NICU of a peri-urban public hospital and all had feeding concerns. An
existing seven-category framework for the classification of suspected dysphagia was
used.
Results: Feeding characteristics of the participants demonstrated that 65.0% had
previous enteral tube (NGT/OGT) feeding, and only 15.6% were referred for
instrumental assessments such as a VFSS by doctors or speech-language therapists
(SLTs). The majority of participants used a mixed manner of feeding such as cup and
breastfeeding, or cup and syringe feeding. Only 29.7% of participants was able to
breastfeed exclusively which was an indication of feeding difficulties as the hospital
where the study was conducted promotes exclusive breastfeeding. Results indicated
that the majority of participants (90.04%) presented with multiple medical conditions.
Underlying neurological conditions (48.48%) and feeding difficulties secondary to
systemic illness (65.80%) contributed mostly to suspected dysphagia in the sample.
It was found that 70.99% of infants presented with feeding difficulties secondary to
other conditions such as LBW and prematurity, highlighting the need for an
expanded dysphagia classification framework.
Conclusion: The results are in agreement with the outcomes of previous research
and confirm the need for a unique classification framework for dysphagia in South
Africa. Neonatal dysphagia is a complex condition and frequently associated with
multiple risk factors.
