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The use of pulse oximetry as a screening assessment for paediatric neurogenic dysphagia 

Authors: A. T. Morgan ab;  R. OMahoney b; H. Francis b
Affiliations:   a Developmental Cognitive Neuroscience Unit, UCL, Institute of Child Health, UK
b The Children's Trust Paediatric Rehabilitation Centre, Surrey, UK
DOI: 10.1080/17518420701439910
Publication Frequency: 6 issues per year
Published in: journal Developmental Neurorehabilitation, Volume 11, Issue 1 2008 , pages 25 - 38
First Published: 2008
Formats available: HTML (English) : PDF (English)
Previously published as: Pediatric Rehabilitation (1363-8491, 1464-5270) until 31 December 2006
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Abstract

Purpose: Early screening and intervention for dysphagia is crucial to offset potential outcomes such as compromised nutrition or reduced respiratory function. Current paediatric dysphagia screening tests are subjective with poor sensitivity and specificity. The present study examined whether an objective method, pulse oximetry (measuring oxygen saturation (SpO2) levels), could differentiate between children with and without dysphagia, in relation to (1) Average pre-feeding baseline SpO2 levels; (2) Average feeding SpO2 levels; (3) Average post-feeding SpO2 levels; and (4) The number of events of oxygen desaturation pre-, during and after feeding.

Methods: Nine participants with chronic neurological disability (CND) (7 F, 2 M) (9;7-15;11 years) and nine control participants matched for age (9;5-16;0 years) and sex were assessed using a clinical bedside evaluation (CBE) and pulse oximetry.

Results: A statistically significant difference was found in SpO2 levels between the two groups (p < 0.001) during oral feeding only (sensitivity, 88.9%; specificity, 88.9%). Only three children with dysphagia experienced 'events' of SpO2 desaturation during feeding.

Conclusion: Pulse oximetry may provide a useful adjunct to the CBE for dysphagia screening, with average SpO2 levels during feeding predicting those with and without dysphagia with moderate levels of sensitivity and specificity. The finding of individual variation in desaturation 'events', however, warrants the provision of further data on large homogenous populations to provide definitive criterion for pathological SpO2 levels associated with dysphagia during oral feeding.

Propoacutesito: El estudio y la intervencioacuten temprana de la disfagia es crucial para tener potencial offset resultados tales como la nutricioacuten comprometida, o la reduccioacuten de la funcioacuten respiratoria. Las pruebas de estudio de la disfagia en pacientes pediaacutetricos son subjetivas y con una especificidad y sensibilidad pobres. El presente estudio evaluoacute siacute un meacutetodo objetivo como la oximetriacutea de pulso (midiendo los niveles de saturacioacuten de oxiacutegeno(SpO2) podriacutea diferenciar entre nintildeos con y sin disfagia, en base a: 1. Promedio de los niveles baasales de SpO2 antes de la alimentacioacuten. 2. Promedio de los niveles de SpO2 durante la alimentacioacuten. 3. Promedio de niveles de SpO2 despueacutes de la alimentacioacuten. 4. El nuacutemero de eventos de desaturacioacuten de oxiacutegeno antes, durante y despueacutes de la alimentacioacuten. Meacutetodos: Se evaluaron a nueve participantes con una discapacidad neuroloacutegica croacutenica (CND) (7F, 2M)(9;7 A 15;11 antildeos) y a nueve participantes de grupo control de igual geacutenero y con edades similares (9;5 a 16;0 antildeos); usando una evaluacioacuten cliacutenica para pacientes encamados (CBE) junto con la oximetriacutea de pulso. Resultados: Se encontroacute una diferencia estadiacutesticamente significativa en los niveles de SpO2 entre los dos grupos (p < 0.001) solamente durante la alimentacioacuten oral (sensiblidad, 88.9%; especificidad, 88,9%). Solamente tres nintildeos con disfagia experimentaron “eventos” de desaturacioacuten de SpO2 durante la alimentacioacuten. Conclusioacuten: La oximetriacutea de pulso puede ser uacutetil para la evaluacioacuten de la disfagia en CBE, utilizando el promedio de los niveles de SpO2 durante la alimentacioacuten, y prediciendo con niveles moderados de sensibilidad y especificidad quienes cursaraacuten con disfagia y quienes no. El resultado de variaciones individuales en los “eventos “de desaturacioacuten, aseguraraacute la obtencioacuten subsecuente de datos en grandes poblaciones homogeacuteneas y brindaraacute los criterios definitivos para determinar los niveles de SpO2 patoloacutegicos asociados a disfagia durante la alimentacioacuten oral. Palabras claves: Discapacidad neuroloacutegica, discapacidad intelectual, nintildeo, disfagia, alteraciones en la deglucioacuten, oximetriacutea de pulso
Keywords: Neurological impairment; intellectual disability; child; dysphagia; deglutition disorder; pulse oximetry
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