NYU Winthrop Hospital’s Neonatal Intensive Care Unit (NICU) is ranked among the best in the world concerning overall survival of extremely premature babies. This recognition by the prestigious Vermont Oxford Registry Network, an authority on the measurement of care and outcomes for high-risk infants worldwide, compared NYU Winthrop to more than 800 NICUs. With a novel approach for detecting dysphagia, a common feeding and swallowing issue, its ranking may improve.
Dysphagia impacts 30 to 70 percent of preterm infants with very low birth weight who have difficulty passing liquid from their mouth to throat and into the esophagus. This can result in aspiration, where liquid gets into the windpipe and lungs, and may lead to pneumonia and other lung conditions.
Nazeeh N. Hanna, MD, chief of the Division of Neonatology at NYU Winthrop Hospital, and his research team have developed a novel, safe, and successful diagnostic method to detect dysphagia that is currently used in the NICU. The technique involves using fiberoptic endoscopic evaluation of swallowing (FEES) with video fluoroscopy swallow study (VFSS) simultaneously. NYU Winthrop is believed to be the only hospital in the U.S. employing this new dual approach, which Dr. Hanna believes may soon become a standard of care.
“Our dual diagnostic approach is a major advancement in detecting potential health risks among the most vulnerable of the preterm infant population,” says Dr. Hanna. “We expect our discoveries to prompt a paradigm shift in approaches to diagnosing and treating dysphagia in preterm infants, immediately providing clinicians with improved techniques, methodologies, and applications that can impact clinical practice in NICUs throughout the country. These changes in standards of care may improve neonatal outcomes and decrease medical costs.”
FEES and VFSS, independent of one another, were helpful diagnostic tools but had limitations. VFSS, which must be done in a radiology office, was the only available tool to study a preterm infant’s ability to swallow safely. One disadvantage is the use of radiation that cannot be done repeatedly. Others include an inability to use during breastfeeding, and associated risks with bringing a preterm infant to a medical practice.
FEES, a portable bedside endoscopy test, has been used with adult patients for decades but rarely for newborns. NYU Winthrop’s preliminary data shows that FEES identified dysphagia in 69 percent of all swallows compared with 60 percent for VFSS, and when combined, provided an even more comprehensive picture. The two tests are now used for initial screenings of preterm infants in our NICU, with follow-up FEES tests as the baby further develops.
NYU Winthrop also uses a groundbreaking therapy for dysphagia by feeding the preterm infant cold milk. Dr. Hannah’s research team found that cold milk startles the pharynx, triggering the brain to initiate more efficient swallowing movements. A similar cold-feeding approach is used for adult stroke and throat cancer patients who have difficulty swallowing but has not been a standard of care for infants.
“Feeding a preterm infant cold milk startles the infant’s swallowing mechanism, just as a person might be startled if someone puts an ice cube to their skin, prompting the baby’s swallowing efforts to be much more effective,” adds Dr. Hanna.
NYU Winthrop Hospital’s Division of Neonatology has shown cold liquid to be very effective in short-duration feedings, reducing dysphagia occurrences from 71 to 26 percent. Dr. Hanna’s team is investigating the effects of using cold milk for an entire feeding, and believes this research will lead to changes in best practices for managing dysphagia in preterm infants.