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      Systematic Review: Non-Instrumental Swallowing and Feeding Assessments in Pediatrics

      , , ,
      Dysphagia
      Springer Nature

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          Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness

          Introduction Dysphagia is common among survivors of critical illness who required mechanical ventilation during treatment. The risk factors associated with the development of postextubation dysphagia, and the effects of dysphagia on patient outcomes, have been relatively unexplored. Methods We conducted a retrospective, observational cohort study from 2008 to 2010 of all patients over 17 years of age admitted to a university hospital ICU who required mechanical ventilation and subsequently received a bedside swallow evaluation (BSE) by a speech pathologist. Results A BSE was performed after mechanical ventilation in 25% (630 of 2,484) of all patients. After we excluded patients with stroke and/or neuromuscular disease, our study sample size was 446 patients. We found that dysphagia was present in 84% of patients (n = 374) and classified dysphagia as absent, mild, moderate or severe in 16% (n = 72), 44% (n = 195), 23% (n = 103) and 17% (n = 76), respectively. In univariate analyses, we found that statistically significant risk factors for severe dysphagia included long duration of mechanical ventilation and reintubation. In multivariate analysis, after adjusting for age, gender and severity of illness, we found that mechanical ventilation for more than seven days remained independently associated with moderate or severe dysphagia (adjusted odds ratio (AOR) = 2.84 [interquartile range (IQR) = 1.78 to 4.56]; P < 0.01). The presence of severe postextubation dysphagia was significantly associated with poor patient outcomes, including pneumonia, reintubation, in-hospital mortality, hospital length of stay, discharge status and surgical placement of feeding tubes. In multivariate analysis, we found that the presence of moderate or severe dysphagia was independently associated with the composite outcome of pneumonia, reintubation and death (AOR = 3.31 [IQR = 1.89 to 5.90]; P < 0.01). Conclusions In a large cohort of critically ill patients, long duration of mechanical ventilation was independently associated with postextubation dysphagia, and the development of postextubation dysphagia was independently associated with poor patient outcomes.
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            Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches.

            J Arvedson (2007)
            Assessment of infants and children with dysphagia (swallowing problems) and feeding disorders involves significantly more considerations than a clinical observation of a feeding. In addition to the status of feeding in the child, considerations include health status, broad environment, parent-child interactions, and parental concerns. Interdisciplinary team approaches allow for coordinated global assessment and management decisions. Underlying etiologies or diagnoses must be delineated to every extent possible because treatment will vary according to history and current status in light of all factors that are often interrelated in complex ways. A holistic approach to evaluation is stressed with a primary goal for every child to receive adequate nutrition and hydration without health complications and with no stress to child or to caregiver. Instrumental swallow examinations that aid in defining physiological swallowing status are needed for some children. Successful oral feeding must be measured in quality of meal time experiences with best possible oral sensorimotor skills and safe swallowing while not jeopardizing a child's functional health status or the parent-child relationship. (c) 2008 Wiley-Liss, Inc.
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              Temperament in early childhood.

              The structure of temperament proposed by the New York Longitudinal Study (NYLS) of Thomas and collaborators (1963, 1968) was compared to Buss and Plomin's (1975) EASI temperament theory. An objective inventory was developed for the NYLS temperaments. Mothers rated 182 children on both NYLS and EASI temperaments. Only two of the nine NYLS dimensions, attention span-persistence and distractibility, were supported by factor analysis. The four EASI dimensions (emotionality, activity, sociability, and impulsivity) were replicated. A similar sociability factor emerged from both the NYLS and EASI systems, but other temperaments were unique. The NYLS and EASI systems were merged to form the Colorado Childhood Temperament Inventory, a parental rating instrument for children 1-6 years of age.
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                Author and article information

                Journal
                Dysphagia
                Dysphagia
                Springer Nature
                0179-051X
                1432-0460
                February 2016
                November 25 2015
                February 2016
                : 31
                : 1
                : 1-23
                Article
                10.1007/s00455-015-9667-5
                312077f4-ff81-4e63-826a-bce946146539
                © 2016

                http://www.springer.com/tdm


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