title: Infant Videofluoroscopic Swallow Study Testing, Swallowing Interventions, and Future Acute Respiratory Illness.
abstract: Tube feedings are commonly prescribed to infants with swallowing abnormalities detected by videofluoroscopic swallow study (VFSS), but there are no studies demonstrating efficacy of these interventions to reduce risk of acute respiratory illness (ARI). We sought to measure the association between swallowing interventions and future ARI, among VFSS-tested infants.
  
  
  
  Retrospective cohort of all infants (<12 months) tested with VFSS at a children's hospital between January 1, 2010, and January 1, 2012. Hospital ARI encounters (emergency, observation, or inpatient status) in a 22-hospital integrated health care delivery system, between the first VFSS and age 3 years, were measured. VFSS results were grouped by normal, intermediate, and oropharyngeal aspiration (OPA), with OPA further subdivided by silent versus cough and thin versus thick liquid OPA. Cox regression modeled the association between swallowing interventions (thickened or nasal tube feedings) and ARI, accounting for changes in swallowing and interventions over time.
  
  
  
  576 infants were tested with a VFSS in their first year of life, receiving a total of 1051 VFSSs in their first 3 years of life. More than 60% of infants received a measured feeding intervention. With the exception of infants with silent OPA who received thickened feedings, neither thickening nor nasal tube feedings, compared with no intervention, were associated with a decreased risk of subsequent ARI.
  
  
  
  Swallowing interventions and repeated testing are common among VFSS-tested infants. However, the importance of diagnosing and intervening on VFSS-detected swallowing abnormalities for the majority of tested infants remains unclear.
authors.affiliation: Divisions of Pediatric Inpatient Medicine, and eric.coon@hsc.utah.edu.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Coon
authors.affiliation: Divisions of Pediatric Inpatient Medicine, and.|Institute for Health Care Leadership, Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
authors.affiliation: Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah; and.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Stoddard
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
authors.forename: Sheena
authors.initials: S
authors.lastname: Reilly
authors.affiliation: Divisions of Pediatric Inpatient Medicine, and.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maloney
authors.affiliation: Pediatric Critical Care Medicine, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
mesh_terms: D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D003938:Diagnostic Techniques, Digestive System; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D015203:Reproducibility of Results; D053120:Respiratory Aspiration / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D014589:Utah; D014743:Videotape Recording / Q000379:methods