Our Summary

This research paper is about a study conducted on infants with a birth defect called congenital diaphragmatic hernia (CDH). These babies often need help to breathe using a method called non-invasive positive pressure ventilation or a high flow nasal cannula, which can lead to problems with swallowing and delays in starting to feed by mouth.

The researchers developed a new care strategy, led by a specialist in swallowing disorders (dysphagia). This involved an early assessment by an occupational therapist or speech/language pathologist, and a specific type of x-ray called a modified barium swallow study (MBSS) to check if the baby was ready to start feeding by mouth.

The study aimed to look back and compare a group of babies who received this new care strategy (intervention cohort) with a group who didn’t (control cohort), to see if the new strategy had an impact on when the babies started oral feeding.

The paper describes how the new strategy was developed and implemented, and shares the results of the x-ray tests for the babies in the intervention group. It then compares the two groups.

The researchers found that the two groups were similar in terms of their prenatal (before birth) and newborn characteristics, including when they were taken off breathing support. However, much more babies in the intervention group were on breathing support when they started feeding by mouth.

None of the babies in the control group had the x-ray test while on respiratory support. Of the intervention group, 15 babies had the x-ray test while on breathing support, and 6 of these showed no signs of swallowing problems.

The control group babies started oral feeding sooner after coming off breathing support and reached full oral feeding earlier than the intervention group. However, there was no difference between the groups in the rate of needing a feeding tube placed in their stomach.

The researchers conclude that monitoring by a swallowing disorder specialist and assessment using clinical and x-ray methods are crucial to safely start oral feeding in babies with CDH. They also suggest that more research is needed to see the long-term effects on feeding progression in these babies.

FAQs

  1. What is the role of the dysphagia provider-led protocol in managing infants with congenital diaphragmatic hernia (CDH)?
  2. How does non-invasive positive pressure ventilation affect the initiation of oral feeding in infants with CDH?
  3. What is the significance of a modified barium swallow study (MBSS) in determining the readiness for oral feeding of infants with CDH?

Doctor’s Tip

A helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to work closely with a dysphagia provider and undergo a modified barium swallow study to assess readiness for oral feeding initiation/advancement on non-invasive positive pressure ventilation. This can help ensure a safe and successful transition to oral feeding for the infant.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) who require non-invasive positive pressure ventilation or high flow nasal cannula are typically recommended for congenital diaphragmatic hernia repair. These patients are at risk for aspiration and delayed initiation of oral feeding, and may benefit from early consultation with a dysphagia provider and modified barium swallow study to assess readiness for oral feeding initiation/advancement. It is important to closely monitor these patients to determine the safety of initiating oral feeding and to ensure appropriate feeding progression.

Timeline

  • Prenatal diagnosis of congenital diaphragmatic hernia
  • Birth and neonatal care
  • Placement on non-invasive positive pressure ventilation or high flow nasal cannula
  • Development of dysphagia and need for evaluation
  • Consultation with occupational therapist or speech/language pathologist
  • Modified barium swallow study to assess readiness for oral feeding
  • Initiation of oral feeding on respiratory support in intervention cohort
  • Comparison of control and intervention cohorts in terms of time to initiate oral feeding
  • Monitoring and evaluation for safety of oral feeding progression
  • Potential need for gastrostomy tube placement
  • Continued surveillance for long-term impact on oral feeding progression.

What to Ask Your Doctor

  1. What is congenital diaphragmatic hernia (CDH) and how is it typically treated?
  2. What are the risks and complications associated with CDH repair surgery?
  3. How will the surgery for CDH repair be performed and what is the expected recovery time?
  4. What are the potential long-term effects or complications of CDH repair surgery?
  5. How will the surgery impact my child’s ability to feed orally and when can we expect to start oral feeding?
  6. Will my child require any additional therapy or support for feeding difficulties after the surgery?
  7. What signs or symptoms should I watch for that may indicate a problem with my child’s feeding after the surgery?
  8. Are there any dietary restrictions or special care instructions I should follow after the surgery?
  9. How frequently should my child be monitored for feeding difficulties or complications following CDH repair surgery?
  10. Are there any resources or support groups available for families of children with CDH who have undergone surgery?

Reference

Authors: Schwab ME, Crennan M, Burke S, Sang H, Klarich MK, Keller RL, Vu LT. Journal: Dysphagia. 2022 Oct;37(5):1305-1313. doi: 10.1007/s00455-021-10391-4. Epub 2022 Jan 4. PMID: 34981254