Dysphagia impacts 30–70% of very-low-birth-weight preterm infants and can result in serious consequences when milk, rather than reaching an infant’s stomach, goes down the wrong way and penetrates the airway (trachea). This can be devastating to fragile, immature lungs and lead to problems such as pneumonia, lung inflammation, and growth compromise. Fortunately, Nazeeh Hanna, MD, Chief of the Division of Neonatology, and his research team have developed a novel diagnostic method for detecting dysphagia that has proven so safe and successful that NYU Winthrop determined it could not withhold using the technique in the NICU, even though the approach is still under study. The technique employs a dual diagnostic approach that involves FEES and VFSS (see descriptions below) done simultaneously. NYU Winthrop is believed to be the only medical center in the U.S. – and possibly the world – employing this new dual approach, which the Hospital believes will soon become a standard of care.
“Our dual diagnostic approach is a major advancement in detecting potential health risks among the most vulnerable of the preterm infant population,” said Dr. Hanna. “We expect our discoveries to prompt a paradigm shift in approaches to diagnosing and treating dysphagia in preterm infants, immediately providing clinicians with improved techniques, methodologies, and applications that can impact clinical practice in NICUs throughout the country. These changes in standards of care may improve neonatal outcomes and decrease medical costs.”
Previously, there were limited diagnostic tools for detecting dysphagia in preterm infants. FEES and VFSS, independent of one another, were helpful diagnostic tools but had several limitations. VFSS is short for Video Fluoroscopy Swallow Study, or X-ray fluoroscopy, and it has to be done in a radiology suite. Previously, this was the only available tool to study a preterm infant’s ability to swallow safely, but it is not without shortcomings. The main disadvantage is the use of radiation, which means that it cannot be used repeatedly despite the infant developing and changing from week to week. Other disadvantages include an inability to use during breastfeeding and associated risks to transporting a sick, preterm infant to a radiology suite.
The other diagnostic tool, Fiberoptic Endoscopic Evaluation of Swallowing, or FEES, is a bedside portable endoscopy test that has been around for decades for use in evaluating dysphagia in adult patients, but it has rarely been evaluated in neonates. NYU Winthrop’s preliminary data showed that FEES identified dysphagia in 69% of all swallows compared with 60% for VFSS, and when combined, the two diagnostic tools gave an even more comprehensive picture of the infant feeding issue, yielding more specific and sensitive information than obtained through just one test. NYU Winthrop now uses the two tests for initial screenings of preterm infants, after which follow-up tests can use FEES-only for updating information as the baby further develops.