Download PDF
Am J Perinatol 2020; 37(13): 1335-1339
DOI: 10.1055/s-0039-1693715
Original Article

Secretion Management in Tracheostomized Infants using Unconventional Approaches and Outcomes: A Case Series

Hevil Shah
1   Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
,
Sudarshan R. Jadcherla
2   Department of Pediatrics, Nationwide Children's Hospital Abigail Wexner Research Institute, Columbus, Ohio
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective This study aimed to increase the understanding of secretion management in infants with tracheostomies. In this case series, we describe objective evidence for an unconventional approach in infants refractory to conventional management techniques.

Study Design Case study of two NICU infants utilizing high-resolution manometry was undertaken using personalized oral stimulation protocols with fruity foods.

Results Oral stimulation improved infant swallowing to clear secretions and reduce the need for suctioning.

Conclusion Innovative oral stimulation protocols are needed to improve swallowing in high-risk infants.

Keywords

high-resolution manometry - dysphagia - CHARGE - aerodigestive


Publication History

Received: 13 March 2019

Accepted: 07 June 2019

Article published online:
31 July 2019

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Rashnoo P, Daniel SJ. Drooling quantification: correlation of different techniques. Int J Pediatr Otorhinolaryngol 2015; 79 (08) 1201-1205
    CrossrefPubMedGoogle Scholar
  • 2 Bachrach SJ, Walter RS, Trzcinski K. Use of glycopyrrolate and other anticholinergic medications for sialorrhea in children with cerebral palsy. Clin Pediatr (Phila) 1998; 37 (08) 485-490
    CrossrefPubMedGoogle Scholar
  • 3 Bavikatte G, Sit PL, Hassoon A. Management of drooling of saliva. Br J Med Pract 2012; 5: 6
    PubMedGoogle Scholar
  • 4 Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. Am Fam Physician 2004; 69 (11) 2628-2634
    PubMedGoogle Scholar
  • 5 Vandenplas Y, Rudolph CD, Di Lorenzo C. et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2009; 49 (04) 498-547
    CrossrefPubMedGoogle Scholar
  • 6 Jensen PS, Gulati IK, Shubert TR. et al. Pharyngeal stimulus-induced reflexes are impaired in infants with perinatal asphyxia: Does maturation modify?. Neurogastroenterol Motil 2017; 29 (07) 1-16
    CrossrefPubMedGoogle Scholar
  • 7 DeMauro SB, Wei JL, Lin RJ. Perspectives on neonatal and infant tracheostomy. Semin Fetal Neonatal Med 2016; 21 (04) 285-291
    CrossrefPubMedGoogle Scholar
  • 8 Kakodkar K, Schroeder Jr JW. Pediatric dysphagia. Pediatr Clin North Am 2013; 60 (04) 969-977
    CrossrefPubMedGoogle Scholar
  • 9 Norman V, Louw B, Kritzinger A. Incidence and description of dysphagia in infants and toddlers with tracheostomies: a retrospective review. Int J Pediatr Otorhinolaryngol 2007; 71 (07) 1087-1092
    CrossrefPubMedGoogle Scholar
  • 10 Rosingh HJ, Peek SH. Swallowing and speech in infants following tracheotomy. Acta Otorhinolaryngol Belg 1999; 53 (01) 59-63
    PubMedGoogle Scholar
  • 11 DeVita MA, Spierer-Rundback L. Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes. Crit Care Med 1990; 18 (12) 1328-1330
    CrossrefPubMedGoogle Scholar
  • 12 Abraham SS, Wolf EL. Swallowing physiology of toddlers with long-term tracheostomies: a preliminary study. Dysphagia 2000; 15 (04) 206-212
    CrossrefPubMedGoogle Scholar
  • 13 Blake KD, Hartshorne TS, Lawand C, Dailor AN, Thelin JW. Cranial nerve manifestations in CHARGE syndrome. Am J Med Genet A 2008; 146A (05) 585-592
    CrossrefPubMedGoogle Scholar
  • 14 Dodds WJ. Physiology of swallowing. Dysphagia 1989; 3 (04) 171-178
    CrossrefPubMedGoogle Scholar
  • 15 Shubert TR, Sitaram S, Jadcherla SR. Effects of pacifier and taste on swallowing, esophageal motility, transit, and respiratory rhythm in human neonates. Neurogastroenterol Motil 2016; 28 (04) 532-542
    CrossrefPubMedGoogle Scholar
  • 16 Jadcherla SR. Advances with neonatal aerodigestive science in the pursuit of safe swallowing in infants: invited review. Dysphagia 2017; 32 (01) 15-26
    Google Scholar
  • 17 Joseph RA, Evitts P, Bayley EW, Tulenko C. Oral feeding outcome in infants with a tracheostomy. J Pediatr Nurs 2017; 33: 70-75
    CrossrefPubMedGoogle Scholar
  • 18 Jadcherla SR, Khot T, Moore R, Malkar M, Gulati IK, Slaughter JL. Feeding methods at discharge predict long-term feeding and neurodevelopmental outcomes in preterm infants referred for gastrostomy evaluation. J Pediatr 2017; 181: 125-130
    CrossrefPubMedGoogle Scholar
  • 19 Dobbelsteyn C, Peacocke SD, Blake K, Crist W, Rashid M. Feeding difficulties in children with CHARGE syndrome: prevalence, risk factors, and prognosis. Dysphagia 2008; 23 (02) 127-135
    CrossrefPubMedGoogle Scholar
  • 20 Blake KD, Davenport SL, Hall BD. et al. CHARGE association: an update and review for the primary pediatrician. Clin Pediatr (Phila) 1998; 37 (03) 159-173
    CrossrefPubMedGoogle Scholar