519 - Hammersmith Infant Neurological Examination in the Assessment of Preterm Infants with Dysphagia

Publication Number: 519.5183

Ryan T. Pitman, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Andrea Wright, Riley Hospital for Children at Indiana University Health, Plainfield, IN, United States; Emily Scott, Indiana University School of Medicine, Ada, MI, United States

Background: Feeding dysfunction in young children is rising in prevalence as increasing numbers of children born prematurely survive into young childhood. Dysphagia leading to aspiration, diagnosed by fluoroscopic swallow study (VFSS), requires intensive medical support to prevent untoward sequelae of dysphagia including slow weight gain, oral aversion, aspiration pneumonia or bronchiectasis. Few tools are available to predict outcomes in infants with dysphagia. Many children with dysphagia have impaired oromotor function and difficulty in mobilizing and clearing airway secretions, in part due to dyscoordination of oropharyngeal muscles involved in masticating and swallowing, theorized to be related to reduced muscle tone. The Hammersmith Infant Neurological Examination (HINE) is designed and optimized to identify differences in motor tone and coordination in infant development. HINE is currently used to identify infants at risk for developing cerebral palsy (CP).

Objective: We sought to determine if HINE scores are associated with VFSS findings or short term outcomes in young infants with dysphagia.

Design/Methods: In this retrospective study, we compared HINE scores with VFSS results and dysphagia outcomes in a cohort of children seen in the Riley Early Years Program, a multidisciplinary clinic for children who received care in the NICU or have early feeding difficulties. The HINE exam was performed at the initial clinic visit or at the first visit after 3 months of age. Demographic data including gestational age, neonatal complications and comorbid diagnosis were identified. VFSS findings included age at time of the study, penetration-aspiration scores, and SLP recommendations for feeding modifications, including tube feeding for enteral nutrition or modified oral feeding including thickened liquids.

Results: 67 patients underwent both HINE testing (mean corrected age 3.3 mo SD 0.62) and VFSS (2.3 mo SD 3.03). By linear regression, HINE scores do not correlate with penetration or aspiration om VFSS but are associated with a recommendation for modified nutrition (thickened liquid or tube feeding) (p < 0.001). Further, HINE scores positively correlate with severe dysphagia (aspiration on VFSS or need for tube feeding) at initial VFSS (p=0.018) and at follow-up (8.4 mo SD 6.4) (p=0.005).

Conclusion(s): HINE scores are associated with feeding outcomes at initial VFSS in young premature infants with dysphagia and inform short-term outcomes. Future prospective research can aim to develop a more complete understanding of early neurologic testing and outcomes for children with dysphagia.

Comparison of HINE scores with VFSS results and feeding outcomes in premature infants.
HINE PAS Table 1.pdfLinear regression of HINE score and frequency of penetration, aspiration, feeding outcomes and severity of dysphagia in premature infants. Feeding modifications include modification of bottle feeds, thickening of liquids or recommendation for tube feeding for enteral nutrition. Severe dysphagia is defined as presence of aspiration on VFSS or recommendation for tube feeding as primary means of nutrition.

Comparison of HINE scores with VFSS results and feeding outcomes in premature infants.
HINE PAS Table 1.pdfLinear regression of HINE score and frequency of penetration, aspiration, feeding outcomes and severity of dysphagia in premature infants. Feeding modifications include modification of bottle feeds, thickening of liquids or recommendation for tube feeding for enteral nutrition. Severe dysphagia is defined as presence of aspiration on VFSS or recommendation for tube feeding as primary means of nutrition.