Clinical and Fiberoptic Endoscopic Evaluation of Swallowing in Robin Sequence Treated with Nasopharyngeal Intubation: The Importance of Feeding Facilitating Techniques

Abstract

Objective To evaluate oral feeding capacity, the swallowing process, and risk for aspiration, both clinically and during fiberoptic endoscopic evaluation of swallowing, in infants with isolated Robin sequence treated exclusively with nasopharyngeal intubation and feeding facilitating techniques. Design Longitudinal and prospective study. Setting Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru, Brazil. Patients Eleven infants with isolated Robin sequence, under 2 months of age, treated with nasopharyngeal intubation. Interventions Feeding facilitating techniques were applied in all infants throughout the study period. The infants were evaluated clinically and through fiberoptic endoscopic evaluation of swallowing at first, second, and, if necessary, third week of hospitalization (T1, T2, T3). The mean volume of ingested milk was registered during clinical evaluation, and events were registered during feeding. Results The respiratory status of all infants was improved after nasopharyngeal intubation; 72% of them presented risk for aspiration during fiberoptic endoscopic evaluation of swallowing at T1. This risk was less frequent when thickened milk was given to the infants and at subsequent evaluations (T2 and T3). Conclusions Nasopharyngeal intubation aids in stabilizing the airway in isolated Robin sequence, but it does not relate directly to feeding. The risk for aspiration was present in most of the infants, mainly during the first week of hospitalization, and improved within a few weeks, after the use of feeding facilitating techniques.