The Effect of Pulse Rate on Neonatal Modified Barium Swallow Study Rating and Recommendations
Faculty Advisor Name
Cynthia R O’Donoghue, Ph.D., CCC-SLP, FNAP
Department
Department of Communication Sciences and Disorders
Description
In the U.S. 116,000 newborn infants are diagnosed yearly with swallowing disorders (dysphagia). Modified Barium Swallow Studies (MBS), also called videofluoroscopic swallowing exams, are the gold standard for assessing the presence and severity of pediatric swallowing impairments. MBS is commonly performed on infants in the Neonatal Intensive Care Unit (NICU) as the consequences of dysphagia are detrimental in this fragile population.
This study investigates the benefits of using 30 pulse-per-second (pps) during Modified Barium Swallow Studies (MBSS) completed on patients in the Neonatal Intensive Care Unit (NICU). A concern from the medical care team regarding the use of MBSS is radiation exposure, particularly given the high number of radiologic procedures completed on these medically-complex infants. One approach to reduce radiation exposure during MBSS is to lower the fluoroscopic pulses (from 30 to 15 pulse per second). Previous studies on adult and pediatric populations indicate that reducing pulse per second (pps) during MBSS decreases the quality of imaging, changes ratings of swallow performance, and may alter the feeding recommendations. However, there are no studies addressing this question for neonates.
This two-part study explores the effect of pulse rate in the NICU population using MBSS previously recorded for neonatal patients in the Virginia Commonwealth University Health NICU.
METHODS
In Part 1, video recordings of previously completed MBSS were collected from a level 4 NICU. These video recordings (originally recorded at 30pps) were copied, and the duplicates transformed to mimic 15 pps by removing every-other frame. Videos were then analyzed by two expert raters who rated five swallow parameters, including location of bolus at time of swallow and presence and severity of airway invasion. Those ratings were then compared across pulse rate. In Part 2, two expert raters were asked to make feeding recommendations based on the swallow parameter ratings from Part 1. Feeding recommendations were compared between MBSS analyzed at 30 and 15pps.
RESULTS
Part 1 of the study found that while there were differences in swallow ratings between the two pulse rates, only one parameter was statistically significantly different (Z = 49.00, p = .024 ). The lack of significance in other parameters such as the Penetration Aspiration Scale (Z = 30.00, p = .317 ) may be a result of low power given the small sample size. However, Part 2 of the study revealed that these small differences in swallow parameter ratings resulted in clinically significant differences in feeding recommendations. In the most extreme case, when one MBSS was judged at 15 pps, the infant was recommended to have a relatively normal feeding plan; but when that same MBSS was judged at 30 pps, the infant was recommended to not eat by mouth at all.
CONCLUSION
While only one swallow parameter was found to be statistically significantly different in this preliminary study, the effects of differences in ratings had clinically significant consequences on feeding recommendations for fragile NICU infants. Therefore, it is recommended that MBSS conducted on NICU infants be completed at 30 rather than 15 pps.
The Effect of Pulse Rate on Neonatal Modified Barium Swallow Study Rating and Recommendations
In the U.S. 116,000 newborn infants are diagnosed yearly with swallowing disorders (dysphagia). Modified Barium Swallow Studies (MBS), also called videofluoroscopic swallowing exams, are the gold standard for assessing the presence and severity of pediatric swallowing impairments. MBS is commonly performed on infants in the Neonatal Intensive Care Unit (NICU) as the consequences of dysphagia are detrimental in this fragile population.
This study investigates the benefits of using 30 pulse-per-second (pps) during Modified Barium Swallow Studies (MBSS) completed on patients in the Neonatal Intensive Care Unit (NICU). A concern from the medical care team regarding the use of MBSS is radiation exposure, particularly given the high number of radiologic procedures completed on these medically-complex infants. One approach to reduce radiation exposure during MBSS is to lower the fluoroscopic pulses (from 30 to 15 pulse per second). Previous studies on adult and pediatric populations indicate that reducing pulse per second (pps) during MBSS decreases the quality of imaging, changes ratings of swallow performance, and may alter the feeding recommendations. However, there are no studies addressing this question for neonates.
This two-part study explores the effect of pulse rate in the NICU population using MBSS previously recorded for neonatal patients in the Virginia Commonwealth University Health NICU.
METHODS
In Part 1, video recordings of previously completed MBSS were collected from a level 4 NICU. These video recordings (originally recorded at 30pps) were copied, and the duplicates transformed to mimic 15 pps by removing every-other frame. Videos were then analyzed by two expert raters who rated five swallow parameters, including location of bolus at time of swallow and presence and severity of airway invasion. Those ratings were then compared across pulse rate. In Part 2, two expert raters were asked to make feeding recommendations based on the swallow parameter ratings from Part 1. Feeding recommendations were compared between MBSS analyzed at 30 and 15pps.
RESULTS
Part 1 of the study found that while there were differences in swallow ratings between the two pulse rates, only one parameter was statistically significantly different (Z = 49.00, p = .024 ). The lack of significance in other parameters such as the Penetration Aspiration Scale (Z = 30.00, p = .317 ) may be a result of low power given the small sample size. However, Part 2 of the study revealed that these small differences in swallow parameter ratings resulted in clinically significant differences in feeding recommendations. In the most extreme case, when one MBSS was judged at 15 pps, the infant was recommended to have a relatively normal feeding plan; but when that same MBSS was judged at 30 pps, the infant was recommended to not eat by mouth at all.
CONCLUSION
While only one swallow parameter was found to be statistically significantly different in this preliminary study, the effects of differences in ratings had clinically significant consequences on feeding recommendations for fragile NICU infants. Therefore, it is recommended that MBSS conducted on NICU infants be completed at 30 rather than 15 pps.
