Incidence of aspiration in infants with single‐ventricle physiology following hybrid procedure

Background Swallowing dysfunction is a known complication for infants with complex congenital heart disease (CHD), but few studies have examined swallowing outcomes following the hybrid procedure for stage 1 palliation in children with single ventricle physiology. Objectives (1) Identify the inciden...

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Bibliographic Details
Published in:Congenital heart disease 2018-09, Vol.13 (5), p.706-712
Main Authors: Lundine, Jennifer P., Dempster, Robert, Carpenito, Kirby, Miller‐Tate, Holly, Burdo‐Hartman, Wendelin, Halpin, Elizabeth, Khalid, Omar
Format: Article
Language:English
Subjects:
Cardiac Surgical Procedures - adverse effects
Children
Congenital diseases
Deglutition - physiology
Deglutition Disorders - epidemiology
Deglutition Disorders - etiology
Deglutition Disorders - physiopathology
dysphagia
Female
Follow-Up Studies
Heart Defects, Congenital - surgery
Heart Ventricles - abnormalities
Heart Ventricles - surgery
Humans
hybrid procedure
hypoplastic left heart syndrome
Incidence
Infant, Newborn
Infants
Male
Ohio - epidemiology
Physiology
Postoperative Complications
Retrospective Studies
Sensitivity analysis
single ventricle
Swallowing
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Summary:Background Swallowing dysfunction is a known complication for infants with complex congenital heart disease (CHD), but few studies have examined swallowing outcomes following the hybrid procedure for stage 1 palliation in children with single ventricle physiology. Objectives (1) Identify the incidence of aspiration in all infants with single ventricle physiology who underwent the hybrid procedure and (2) Compare results of clinical bedside and instrumental swallowing evaluations to examine the predictive value of a less invasive swallowing assessment for this population of high‐risk infants. Methods This was a retrospective cohort chart review study. All patients with single‐ventricle physiology who underwent the hybrid procedure received a referral for subsequent instrumental swallow assessment during a 4‐year period. Results from clinical bedside evaluations were compared to those of the instrumental assessment. Results Fifty infants were included in this study. During instrumental swallow assessment, aspiration was observed in 28% of infants following the hybrid procedure. Normal swallowing function was identified in 44% of infants, and 28% demonstrated laryngeal penetration. Neither length of intubation nor prematurity were found to be predictors of aspiration. Thirty‐six of these infants were assessed via clinical bedside evaluation prior to the instrumental evaluation. The sensitivity of the clinical bedside evaluation was 0.73 and the specificity was 0.92. Conclusions This study reports on a cohort of infants with single ventricle physiology following the hybrid procedure and found the incidence of aspiration to be lower than previously reported. Improved clinical bedside evaluation guidelines are needed so that clinicians can predict more reliably which infants are at risk for aspiration following the hybrid procedure.
ISSN:1747-079X
1747-0803
DOI:10.1111/chd.12636