Live Monitoring Allows Detection of Silent Aspiration in Prader-Willi Infants

Silent aspiration, a consequence of a swallowing dysfunction, was detected in infants with Prader-Willi syndrome (PWS) by fluorescent live video, a study found.

The research was published in the journal Medicine (Baltimore) in a study titled, “Silent aspiration in infants with Prader-Willi syndrome identified by videofluoroscopic swallow study.”

PWS infants usually have feeding difficulties and may require feeding tubes for partial or full nutrition. Feeding difficulties are currently not properly evaluated or managed in these babies.

Problems with swallowing are associated with an increased risk of respiratory complications and choking, which are highly prevalent in Prader-Willi babies. Swallowing impairments may also be related to sudden death, probably due to sleep-disordered breathing.

Several studies showed the potential use of objective measures to properly evaluate sleep-disordered breathing, such as polysomnography, a type of sleep study that uses numerous tests to monitor body functions, including brain, eye movement, heart rhythm, and muscle activity during sleep.

But little is known about objective measures of swallowing dysfunctions. In this field, a promising technology called videofluoroscopic swallow studies (VFSS) may provide powerful clues.

In the study, researchers investigated the use of VFSS to characterize swallowing malfunctions suspected by clinicians during a feeding evaluation.

The research consisted of a retrospective review of 23 videofluoroscopic swallow studies in 10 Prader-Willi infants with an average age of 9.7 months (age range was 3 weeks to 29 months).

Using this information, researchers evaluated possible associations between gender, genetic characteristics, and the use of growth hormone on aspiration incidence. Growth hormone is generally administrated to Prader-Willi babies and is linked to improved motor development and strength.

Polysomnography studies were conducted in the same babies about one year after the videofluoroscopic swallow studies.

The study revealed a high rate of swallowing dysfunction in Prader-Willi infants, with aspiration events in 87% of them and pharyngeal residue in 71%.

Aspiration events were found to be inversely related to food consistency, with aspiration being more likely with thin liquids (84%) than thickened liquids (60%) or purees (14%). All the aspiration events were silent.

Seven of the 10 babies in the study also had their sleep evaluated by polysomnography, and all of them revealed obstructive and/or central sleep apnea.

Researchers found no differences in rates of aspiration for gender, genetic type, or growth hormone (GH) use.

“A high incidence of aspiration was identified, indicating swallow dysfunction may frequently be present in infants with [Prader-Willi syndrome],” the researchers wrote.

“Comprehensive evaluation of feeding and swallowing is essential and requires a multidisciplinary approach … to guide decision-making and optimize feeding safety in [Prader-Willi babies],” they added.