Patient selection: very low birthweight infant
Presentation: drop in oxygen saturation during an oral feeding
A key risk factor is a birth at <= 28 weeks gestation.
A modified barium swallow test may show impaired airway protection with inadequate closure of the epiglottis, laryngeal penetration and/or tracheal aspiration. This tests needs to record multiple swallows since some types of swallowing dysfunction (such as pooled material in the pyriform sinus) may be easily missed if testing is not long enough.
While some infants may be symptomatic when aspirating, others may be asymptomatic (silent aspiration).
Other conditions to consider:
(1) bronchopulmonary dysplasia (associated with oxygen desaturation during oral feedings)
(2) Grade III or IV intraventricular hemorrhage or other major neurological disorder (may be associated with poor feeding ability)
(3) gastroesophageal reflux
