Breastfeeding in infants who aspirate may increase risk of pulmonary inflammation

• Published in: Pediatric pulmonology Vol. 59; no. 3; pp. 600 - 608
• Main Authors: Duncan, Daniel R., Golden, Clare, Larson, Kara, Williams, Nina, Simoneau, Tregony, Rosen, Rachel L.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2024
• Subjects: aspiration; Breast Feeding; Breastfeeding & lactation; breastmilk; Deglutition; Deglutition Disorders - diagnosis; Deglutition Disorders - etiology; Dysphagia; Female; Fluoroscopy - adverse effects; Fluoroscopy - methods; Hospitalization; Humans; Infant; laryngeal penetration; Neutrophils; Pneumonia - complications; Respiratory Aspiration - complications; Retrospective Studies; videofluoroscopic swallow study; videofluoroscopic swallow study; laryngeal penetration; breastmilk; aspiration
• ISSN: 8755-6863; 1099-0496; 1099-0496
• DOI: 10.1002/ppul.26788

Objective To evaluate management strategies and pulmonary outcomes for breastfed infants with oropharyngeal dysphagia. Study Design We performed a retrospective cohort study of breastfed infants diagnosed with oropharyngeal dysphagia with documented aspiration or laryngeal penetration on videofluoroscopic swallow study (VFSS). Medical records were reviewed for VFSS results and speech‐language pathologist recommendations following VFSS, results of chest x‐ray, results of bronchoalveolar lavage (BAL) within 1 year of VFSS, and aspiration‐related hospitalizations occurring before or within 1 year of VFSS. Subjects were categorized as cleared or not cleared to breastfeed based on the VFSS. Proportions were compared with Chi‐square and Fisher's exact tests and means with Student's t‐tests. Results Seventy‐six infants (4.7 ± 0.4 months old) were included; 50% (38) had aspiration and 50% (38) had laryngeal penetration. After VFSS, 70% (53) were cleared to breastfeed while 30% (23) were not cleared to breastfeed. Patients with aspiration were less likely to be cleared to breastfeed (p = .006); however, 55% (21/38) of those with aspiration were still cleared to breastfeed. Infants cleared to breastfeed had significantly more pulmonary hospitalizations (p = .04) and were also at increased risk of elevated neutrophil count (p = .02) and culture growth on BAL (p = .01). Significantly increased abnormal neutrophil count was also found in those cleared to breastfeed with laryngeal penetration (p = .01). Conclusions Infants with oropharyngeal dysphagia counseled to continue breastfeeding had increased risk of BAL inflammation and more pulmonary hospitalizations compared to those that were told to stop breastfeeding.