Cervical Auscultation and Feeding with the Paediatric Population

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Cervical Auscultation and Feeding with the
Paediatric Population

• Evidence Based Practice
• Acute Paediatric Feeding Group 2007

Sophie Egan Senior Paediatric Speech
Pathologist The Wollongong Hospital Sophie.Egan_at_se
siahs.health.nsw.gov.au
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Paediatric Feeding Acute Group Members 2007

• Valerie Gent
• Melissa Parkin
• Colleen Links
• Debbie Alverez
• Jana Carr

• Kate Hodge
• Anne Rosten
• Kimberley Achurch
• Rachel Hampshire
• Brodie 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

• Online searches e.g Ovid, Pubmed, Medline
• Article reference list from previous CA courses
  members had attended
• Contact with No Fuss Feeding Swallowing
  Centre (formerly the PERO clinic) QLD
• We then were ready to perform CAPs on the
• articles 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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Is Cervical Auscultation an applicable tool to
use with infants to describe feeding?

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

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

• 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 evidence
• Methodology different in ALL studies - use of
  high technology, research equipment
• Difficult to replicate in everyday clinical
  practice
• Limited subjects in study designs
• Lack of control subjects
• Found it difficult to answer our specific
  question

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Limitations of CA in general

• Lefton-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 reasons
• Underlying 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 dysphagia
• CA still remains to have a place in our bag of
  clinical tools to augment a clinical assessment
  or review of feeding progress
• Non-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
• FTEs 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 2008
• John Hunter Childrens Hospital
• Meeting every two months (6 times a year)
• CIAP web-site - Information of questions and
  where meetings will be held
• Brodie.Warren_at_hnehealth.nsw.gov.au
• Sophie.Egan_at_sesiahs.health.nsw.gov.au
• 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! ?