Cervical Auscultation and Feeding with the Paediatric Population Evidence Based Practice Acute...

Cervical Auscultation and Feeding with the Paediatric

Population

Evidence Based PracticeAcute Paediatric Feeding Group

2007

Sophie EganSenior Paediatric Speech PathologistThe Wollongong [email protected]

December 2007 EBP Extravaganza - Acute Paediatric Feeding

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Paediatric Feeding Acute Group Members 2007

Valerie GentMelissa ParkinColleen LinksDebbie AlverezJana Carr

Kate HodgeAnne RostenKimberley AchurchRachel HampshireBrodie Warren


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Clinical Question ….. The process

Initially we began with the clinical question:

“Does cervical auscultation improve the identification of

suck/swallow/breathe in-coordination in

neonates/infants?”


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Clinical Question ….. The process Too specific? Other studies have

looked at CA in adult dysphagia

Limited number of articles

What did we really want from the evidence….?


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Clinical Question

Is Cervical Auscultation an applicable tool to use with infants to describe

feeding?


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Various ways to gain evidence

1. Online searches – e.g Ovid, Pubmed, Medline2. Article reference list from previous CA

courses members had attended3. Contact with “No Fuss Feeding & Swallowing

Centre” (formerly the PERO clinic) QLD

We then were ready to perform CAP’s on thearticles that “appeared” to answer our clinical

question


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Is Cervical Auscultation an applicable tool to use with infants to describe feeding?

Vice at al. (1990) –Cervical auscultation of suckle feeding in newborn infants

Found swallow & breath sounds were distinctively patterned

Each breath consisted of an expiration and inspiration sequence

Initial and final discrete sounds before and after bolus transit were evident

The control group data was not included Therefore difficult to describe/define what

constituted a feeding difficulty


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Vice at al (1995). –Correlation of cervical auscultation with physiological recording during suckle feeding in newborn infants

3 different types of swallow patterns were distinguished

Initial and final discrete sounds before and after bolus transit was evident

Discrete sounds may vary in association with differences in swallow-respiration patterns

Limited number and type of subjects - 9 “normal subjects” no comparison of the swallowing patterns to difficult feeders

Combined CA with physiological recordings – CA not isolated, therefore difficulty to replicate in everyday clinical situations


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Reynolds et al. (2002) – Cervical accelerometry in preterm infants

12 subjects, no control group An accelerometer rather than a stethoscope was used Initial discrete sound = not clear what physiological

swallow even this represented Postulated swallow-associated sounds become more

uniform with maturation Proposed that this method could be used to track

maturation in infant feeding and predict infants who will experience difficulty in coordinating the various processes needed for successful feeding


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Da Nobrega et al, (2004) –Acoustic study of swallowing behaviour in premature infants during tube-bottle feeding and bottle feeding

Postulated that all swallowing behaviours during bottle transition for preterm infants were significantly different.

Concluded that the duration of respiration period during transition to bottle feeding was necessarily larger for preterm infants and therefore more recuperation time between groups of swallows was needed.

Did not really assess the applicability of cervical auscultation vs other methods

Limited study:- i.e. no control, randomization and limited number of subjects – therefore ?reliability of study


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WAKE UP TIME………………..


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SUMMARY –what we found

Predominantly Level IV evidenceMethodology different in ALL studies - & use of high technology, research equipment

Difficult to replicate in everyday clinical practiceLimited subjects in study designsLack of control subjectsFound it difficult to answer our specific question


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Limitations of CA in generalLefton-Greif & Loughlin, (1996)

Specialized Studies in paediatric dysphagia

LIMITATIONS: ↓ Limited ability to detect aspiration events↓ Interpretation is listener dependent – inter-

rater reliability still questionable↓ Correlations between sounds heard and

specific swallowing events is often not known

↓ Does not display structures so that reasonsUnderlying impairment are not defined.


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Advantages of CA Easy, available,

non invasive and cost-efficient

No radiation exposure, can sample swallowing repeatedly and for prolonged periods

NO “contrast” required, uses real food or liquid


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SUMMARY –

Overall limited research in the area of paediatric dysphagiaCA still remains to have a place in our “bag” of clinical tools to augment a clinical assessment or review of feeding progressNon-invasive for paediatric population is a BIG PLUS! More research is needed in this area


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Where to from here….?

Benchmarking projects:-

Service delivery Treatment methods FTE’s in NICU - submission to RHW Fussy eaters policy Teats in the NICU


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Contacts and 2008 Brodie Warren - New EBP leader for 2008John Hunter Children’s Hospital Meeting every two months (6 times a year) CIAP web-site - Information of questions

and where meetings will be held [email protected] [email protected] Project discussion and information gathering…


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References Vice Fl, Heinz JM, Giuriati G, Hood M. Bosma JF. Cervical auscultation of suckle

feeding in newborn infants. Developmental medicine & Child Neurology. 32 (9):760-8, 1990 Sept.

Vice FL, Blamford O, Heinz JM, Bosma JF. Correlation of cervical auscultation with physiological recording during suckle-feeding in newborn infants. Developmental Medicine & child Neurology. 37(2): 167-79, 1995 Feb

Da Nobrega, L, Boiron M, Henrot A, Saliba E. (2004) Acoustic study of swallowing behaviour in premature infants during tube-bottle feeding and bottle feeding period. Early Human Development, 78, (2004) 53 – 60.

Reynolds EW, Vice FL, Bosma JF, Gewolb IH, (2002) Cervical accelerometry in preterm infants Development Medical Child Neuorology. Sep; 44 (9):587 – 92

Gewolb IH, Bosma JF, Reynolds EW, Vice FL Integration of suck swallow rhythms in preterm infants with and without pulmonary dysplasia. Development Medicine & Child Neuroology, (2003), May; 45 (5):344-8.

Reynolds EW Vice FL Gewolb IH, Cervical accelerometry in preterm infants with and without pulmonary dysplasia. Developmental Medicine & Child Neurology, (2003), May; 45 (5):442-446.


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References Leslie P, Drinnan MJ, Finn P, Ford GA, Wilson JA, (2004) Reliability and validity

of cervical auscultation: a controlled comparison using videofluroscopy, Dysphagia, 19 (4): 231-40. 2004

Lau c, Smith EO, Schanler RJ, (2003) Coordination of suck-swallow and swallow respiration in pres-term infants. Acta Paediatrica. (2003) 92 (6): 721-7, 2003.

Singhi S. Bhalla AK. Bhandari A. Narang A, Counting respiratory rate in infants under 2 months: comparison between observation and auscultation. Annals of Tropical paedaitrics. 23 920: 135-8, 2003 Jun.

Lefton-Grief and Loughlin (1996) Specialized studies in pediatric dysphagia. Seminars in Speech and Language, 17(4): 311-29.

Comrie and Helm (1997) Common feeding problems in the intensive care nursery: maturation, organization, evaluation and management strategies. Seminars in Speech & Language, 18(3): 239-59


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With thanks…


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Have an enjoyable…


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FUN…


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Safe…


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Christmas


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Everyone!

Cervical Auscultation and Feeding with the Paediatric Population Evidence Based Practice Acute...

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