229 – Evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy during hospitalisation: A case series

Presentation - ECV2022-229

Evolution of swallowing and feeding abilities of neonates with hypoxic-ischaemic encephalopathy during hospitalisation: A case series

Roxanne Malan, University of Pretoria, South Africa (malanroxanne@gmail.com)
Jeannie van der Linde, University of Pretoria, South Africa (jeannie.vanderlinde@up.ac.za)
Alta Kritzinger, University of Pretoria, South Africa (alta.kritzinger@up.ac.za)
Marien Graham, University of Pretoria, South Africa (marien.graham@up.ac.za)
Esedra Krüger, University of Pretoria, South Africa (esedra.kruger@up.ac.za)
Kumeshnie Kollapen, University of Pretoria, South Africa (komeshnie.kollapen@up.ac.za)
Zarina Lockhat, University of Pretoria, South Africa (zarina.lockhat@up.ac.za)

Background: Neonatal hypoxic-ischaemic encephalopathy (HIE) commonly occurs in lower-and middle-income countries and often causes oropharyngeal dysphagia (OPD), but relevant research is limited. Increased understanding of the evolution of swallowing and feeding among affected neonates during hospitalisation may improve speech-language pathology (SLP) service delivery.

Aim: To describe the evolution of swallowing and feeding of neonates with HIE during hospitalisation.

Method: A longitudinal cohort study was used. Twenty-nine participants (median age 39.0 weeks [IQR=2.0 weeks]) were included. Clinical swallowing and feeding assessments were conducted at the introduction of oral feeds and at discharge using the Neonatal Feeding Assessment Scale (NFAS). Video-fluoroscopic swallow studies (VFSS) supplemented the NFAS before discharge.

Results: Approximately two-thirds of participants displayed OPD symptoms during initial NFAS and VFSS. Significantly fewer OPD symptoms occurred at discharge (p=0.004). Sucking endurance (p<0.001), suck-swallow-breathe coordination (p=0.031), and tongue protrusion reactions (p=0.025) significantly improved during hospitalisation. Nine participants (31.0%) demonstrated penetration or aspiration. Most aspiration events were silent (60%). Many participants displayed OPD symptoms regardless of HIE severity.

Conclusions: Neonates with all grades of HIE should be considered for early speech-language pathology intervention before discharge.

Implications for children and families: If your newborn has HIE, they may be at risk of having swallowing and feeding difficulties that can cause health issues. Speech-language pathologists are uniquely equipped to manage swallowing and feeding difficulties, therefore, their early involvement in your newborn’s care is encouraged.

Implications for practitioners: Among neonates with all grades of HIE, early speech-language pathology intervention is recommended for OPD. This study highlighted the value of VFSS in diagnosing OPD. Most aspiration events among participants were silent and may have been missed otherwise.

Key words: Hypoxic-ischaemic encephalopathy; neonate; professionals’ voices, oropharyngeal dysphagia; swallowing and feeding; wellbeing; vulnerable communities

This presentation relates to the following United Nations Sustainable Development Goals:

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