Breastfeeding and swallowing in a neonate with mild hypoxic-ischaemic encephalopathy.
Esedra Krüger, Alta Kritzinger, Lidia Pottas
PMID 28582997WHAT IT FOUND
One neonate with mild HIE and HIV exposure had poor latch, drowsy state and coughing or choking early, then better feeding by Day 13, but a swallow study showed oral phase problems despite no aspiration.
Key findings
01On Day 6, the neonate showed shallow latching and coughing or choking during breastfeeding.
02By Day 13, the neonate latched deeply, stayed on the breast for about 11 min, and had repeated long sucking bursts and repeated swallowing.
03The Day 13 swallow study showed no aspiration or penetration, but poor bolus formation and delayed oral transit.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is a single case report, so it cannot show how all neonates with mild HIE will feed or whether feeding difficulties are expected. The infant received therapeutic hypothermia, CPAP, nasogastric feeding, expressed breast milk, cup feeding, parent guidance, oral stimulation, antiretroviral treatment and antibiotics at the same time, so the effect of any one component cannot be separated. The swallow study was done on Day 13, after several days of speech-language intervention, so it cannot show the infant's untreated swallow pattern at the time of early feeding problems. HIV exposure and septicaemia may also have influenced feeding, and the paper says HIV exposure cannot be separated from the feeding outcome. The study used a case-report design with no comparison group or randomisation.
The easy way to misread this
Do not read the Day 13 improvement as proof that speech-language therapy works, because this is a single case report and the infant also received therapeutic hypothermia, CPAP, nasogastric feeding, expressed breast milk, parent guidance, oral stimulation, antiretroviral treatment and antibiotics.