Table 2.
Feeding and swallowing difficulties in congenital heart disease: definition, assessment and prevalence.
| Author | Definition of FSD | Assessment of FSD | Prevalence of FSD (sample size of study reported as N) |
|---|---|---|---|
| Davis et al. (9) | No clear description/definition of dysphagia provided. Described the method of feeding at discharge. | Not described. | N = 53: 49% required tube feeding at discharge: 25% NGT; 21% NGT + oral; 3% g-tube. 8% aspirated |
| De Souza et al. (10) | Classified according to a protocol: “Classification of the Degree of Pediatric Dysphagia” which includes a range from normal, mild, moderate-severe and severe OPD with a high risk of aspiration, as assessed by an SLT. | Clinical assessment conducted by SLT | N = 31: 74% dysphagia: 32% (10) = mild; 23% (7) = moderate: 19% (6) = severe. |
| Einarson and Arthur (11) | “Infant not entirely orally fed (breast/bottle/both) at the time of discharge from hospital.” | None. | N = 101: 28.7% non-oral feeding at discharge. |
| Hill et al. (12) | Any positive subcategory on the Mealtime Behavior Questionnaire (MBQ) or About Your Child's Eating (AYCE) was considered an indication of feeding difficulty. | MBQ and AYCE questionnaires completed by caregiver. | N = 56: 28 (50%) feeding dysfunction. |
| Kogon et al. (13) | “Postoperative feeding difficulty was defined by: (1) a prolonged time to reach goal feeds; (2) a prolonged transition to oral feeds requiring tube feeds at discharge; and (3) the need for additional procedures to facilitate feeding.” | None | N = 83: 11% required prolonged time to reach full oral feeds (>19 days). 45% discharged home with tube feeding. |
| Kohr et al. (14) | Diagnosis of dysphagia made by SLT after clinical swallowing assessment. | Clinical assessment conducted by SLT | N = 50: Dysphagia 18%. |
| Lundine et al. (15) | Swallowing dysfunction described as penetration or aspiration on VFSS. | VFSS | N = 50: 44% normal; 28% penetration and 28% aspiration (13/14 silent aspiration) on Penetration-Aspiration Scale. |
| Maurer et al. (16) | “Feeding disorder was defined as the presence of one or more of the following three criteria at the age of 2 years, as judged by the primary care provider: (1) partially or completely dependent on tube feeding; (2) feeding behavior is not age-adequate, i.e., only drinks liquids or eats pureed food; (3) failure to thrive, i.e., the weight of the child is below the third percentile.” | None | N = 82: 22% FSD at 2 years. |
| McGrattan et al. (17) | A difficulty in any component noted in the evaluation of the oropharyngeal swallow on VFSS was considered a symptom of dysphagia. | VFSS | N = 36: 83% penetration and 50% aspiration with liquids. |
| McKean et al. (18) | Feeding difficulty was defined as “the requirement for ongoing tube feeding at the time of discharge home or transfer to another hospital.” | None (only 8% had VFSS) | N = 79: 30% discharged with feeding tube. |
| Pham et al. (19) | “An inability to tolerate adequate oral intake without supplementation by nasogastric (NG) tube feeding.” | Not all participants were assessed; assessments included clinical swallowing evaluation, VFSS or an upper GI study | N = 104: 63.5% dysphagia. |
| Pourmoghadam et al. (20) | No clear definition provided. | Clinical assessment by SLT and some underwent oropharyngeal motility study. | N = 89 but only 71 had VFSS: 42% aspiration. 48% vocal cord dysfunction. 53 participants had gastrostomy tube placed. |
| Raulston et al. (21) | No definition provided – assessed clinically and with FEES/VFSS to assess for aspiration. | A clinical swallowing evaluation by SLT and either FEES or VFSS. | N = 96: 51% had aspiration on FEES or VFSS. |
| Skinner et al. (22) | Definition not provided; swallowing dysfunction identified on VFSS results. | VFSS +/- laryngoscopy | N = 51: 52% overall swallowing dysfunction; 28% aspiration. Swallowing dysfunction presented in 48% following Norwood (24% aspiration) and in 59% following Biventricular (35% aspiration). |
| Yi et al. (23) | Dysphagia was defined as one of the following conditions: “(1) feeding desaturation, increased work required for breathing during feeding, coughing/choking during feeding, altered crying, or other signs; (2) failure of any clinical modification in improving oral feeding; and (3) tube feeding until discharge.” | VFSS conducted in 33 of the 35 participants diagnosed with dysphagia. | N = 146: 24% dysphagia. |
AYCE, About Your Child's Eating; FEES, fiberoptic evaluation of swallowing; MBQ, Mealtime Behavior Questionnaire; NG tube, nasogastric tube; OPD, oropharyngeal dysphagia; SLT, speech-language therapist; upper GI, upper gastrointestinal; VFSS, videofluoroscopic swallow study.
Definitions of FSD that were presented in the source articles are presented as direct quotes within quotation marks.
Aspiration was documented on videofluoroscopic swallow studies or fiberoptic endoscopic evaluation of swallowing; vocal cord dysfunction was assessed by laryngoscopy.