title: Laryngeal penetration on videofluoroscopic swallowing study is associated with increased pneumonia in children.
abstract: OBJECTIVE
  To determine whether children with laryngeal penetration on videofluoroscopic swallowing study are at higher risk for pneumonia than those with normal findings.
  
  
  METHODS
  We reviewed the charts of 235 pediatric patients presenting to our Swallowing and Dysphagia clinic for videofluoroscopic swallowing study over a 3-year period. Patients with unsuccessful swallowing studies, incomplete charts, extra-laryngeal etiologies for recurrent pneumonia, or who were lost to follow up were excluded. Out of the 165 patients remaining, 58 had normal findings, 59 had laryngeal penetration, and 48 had tracheobronchial aspiration. The number of cases of pneumonia, aspiration events, and demographic data were recorded for all patients.
  
  
  RESULTS
  Children with laryngeal penetration on videofluoroscopic swallowing study had significantly (P=0.032) more pneumonia than patients with neither penetration nor aspiration (median 2 vs. 0; mean 2.22 vs. 1.60). Furthermore, analysis revealed that glottic abnormalities (e.g. laryngeal cleft) represented a significant independent risk factor (P=0.004) for pneumonia and aspiration, while being diagnosed with a syndrome did not (P=0.343).
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to demonstrate that laryngeal penetration on videofluoroscopic swallowing study is associated with significantly more cases of pneumonia in children. While this remains a retrospective study demonstrating a weak association, the results suggest a need for future prospective studies to evaluate this important clinical question in children.
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada.
authors.forename: Joshua
authors.initials: J
authors.lastname: Gurberg
authors.affiliation: Department of Occupational Therapy, Montreal Children's Hospital, Montreal, Quebec, Canada.
authors.forename: Rena
authors.initials: R
authors.lastname: Birnbaum
authors.affiliation: Division of Pediatric Otolaryngology - Head & Neck Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada. Electronic address: sam.daniel@mcgill.ca.
authors.forename: Sam J
authors.initials: SJ
authors.lastname: Daniel
mesh_terms: D002648:Child; D002675:Child, Preschool; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007223:Infant; D007830:Larynx / Q000503:physiopathology*; D008297:Male; D011015:Pneumonia, Aspiration / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Laryngeal penetration; Pediatric; Pneumonia; Videofluoroscopic swallowing study