Risk of dysphagia in a population of infants born preterm: characteristic risk factors in a tertiary NICU

Abstract Objective: To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. Method: A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. Results: The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). Conclusion: Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.

Risk of dysphagia in a population of infants born pre-term: characteristic risk factors in a tertiary NICU.

OBJECTIVE: To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. METHOD: A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. RESULTS: The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). CONCLUSION: Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.

Effects of Cassava Juice (Manihot esculenta Crantz) on Renal and Hepatic Function and Motor Impairments in Male Rats.

Cassava (Manihot esculenta Crantz) is a plant that contains neurotoxins such as linamarin and lotaustraline. Its long-term consumption is associated with neuronal damage and contributes to the development of motor impairment in humans and rats. We investigated the effects of the consumption of cassava juice on renal and hepatic function and motor impairments in male rats. The rats received the vehicle, non-toxic and toxic doses of cassava juice, or linamarin as a pharmacological control, over 35 consecutive days. The effects were evaluated in an open field test, rotarod, and swim test. The toxic cassava dose and linamarin resulted in motor impairments in the rotarod and swim test from day 7 of treatment. The toxic cassava dose and linamarin increased the parameters that indicate renal and hepatic damage, with the exception of total protein and albumin levels. Behavioral variables that show motor incoordination (i.e., latency to fall in the rotarod) were negatively correlated with biochemical parameters of renal and kidney damage, whereas spin behavior was positively correlated. Our data indicate that chronic oral consumption of cassava juice caused renal and hepatic damage that was correlated with motor coordination impairment in rats, similarly to their principal neurotoxic compound, linamarin.

Deficiência de cobre em suínos: caracterização clínico-patológica / Copper deficiency in swine: clinical-pathologic characterization

São relatados dois casos de deficiência de cobre em suínos (A e B), fêmeas, sem raça definida, de três meses de idade, provenientes de propriedade rural em Planaltina, GO. Os animais apresentavam incoordenação, paresia de membros pélvicos, com progressão para os membros torácicos e andar com flexão da articulação metacarpo-falangeana. Na propriedade de origem dos animais, outros dois suínos apresentavam atrofia da musculatura da coxa e posição sentada quando parados. O rebanho recebia dieta não-balanceada constituída por milho, soro de leite e sobras de lavoura. Na necropsia, não foram observadas alterações significativas, mas histologicamente havia vacuolização periaxonal multifocal no tronco encefálico e na medula espinhal, quantidade discreta de esferoides axonais e macrófagos no interior dos vacúolos. A coloração com azul rápido de luxol (ARL) para mielina demonstrou que as áreas de vacuolização caracterizavam focos de desmielinização. Amostras de fígado dos dois suínos apresentaram níveis de cobre muito abaixo do normal, de 13,1 partes por milhão (ppm) (suíno A) e 5,7ppm (suíno B). Este trabalho descreve dois casos de desmielinização medular e de tronco encefálico devido à deficiência de cobre em suínos jovens.(AU)

Two cases of copper deficiency are described in three-month-old female crossbred piglets from a swine herd in Planaltina, GO. The animals presented incoordination, hindlimbs paresis progressing to the forelimbs, and gait with flexion of the metacarpofalangeal articulation. On the farm of origin of the animals, other two piglets presented atrophy of thigh muscle and sitting position when in station. The herd was fed with unbalanced diet consisting of corn, whey and leftover crop. On necropsy no significant changes were observed, but histologically there was multifocal periaxonal vacuolization in the brainstem and in spinal cord, discrete amount of axonal spheroids and macrophages in the vacuoles. The luxol fast blue (LFB) stain for myelin showed that the vacuolated sites represent demyelinated areas. Liver sample of the two piglets had very low copper levels, 13.1 parts per million (ppm) in swine A and 5.7 (ppm) in swine B. This paper describes two cases of spinal cord and brainstem demyelination due to copper deficiency in piglets.(AU)

Deficiência de cobre em suínos: caracterização clínico-patológica / Copper deficiency in swine: clinical-pathologic characterization

São relatados dois casos de deficiência de cobre em suínos (A e B), fêmeas, sem raça definida, de três meses de idade, provenientes de propriedade rural em Planaltina, GO. Os animais apresentavam incoordenação, paresia de membros pélvicos, com progressão para os membros torácicos e andar com flexão da articulação metacarpo-falangeana. Na propriedade de origem dos animais, outros dois suínos apresentavam atrofia da musculatura da coxa e posição sentada quando parados. O rebanho recebia dieta não-balanceada constituída por milho, soro de leite e sobras de lavoura. Na necropsia, não foram observadas alterações significativas, mas histologicamente havia vacuolização periaxonal multifocal no tronco encefálico e na medula espinhal, quantidade discreta de esferoides axonais e macrófagos no interior dos vacúolos. A coloração com azul rápido de luxol (ARL) para mielina demonstrou que as áreas de vacuolização caracterizavam focos de desmielinização. Amostras de fígado dos dois suínos apresentaram níveis de cobre muito abaixo do normal, de 13,1 partes por milhão (ppm) (suíno A) e 5,7ppm (suíno B). Este trabalho descreve dois casos de desmielinização medular e de tronco encefálico devido à deficiência de cobre em suínos jovens.

Two cases of copper deficiency are described in three-month-old female crossbred piglets from a swine herd in Planaltina, GO. The animals presented incoordination, hindlimbs paresis progressing to the forelimbs, and gait with flexion of the metacarpofalangeal articulation. On the farm of origin of the animals, other two piglets presented atrophy of thigh muscle and sitting position when in station. The herd was fed with unbalanced diet consisting of corn, whey and leftover crop. On necropsy no significant changes were observed, but histologically there was multifocal periaxonal vacuolization in the brainstem and in spinal cord, discrete amount of axonal spheroids and macrophages in the vacuoles. The luxol fast blue (LFB) stain for myelin showed that the vacuolated sites represent demyelinated areas. Liver sample of the two piglets had very low copper levels, 13.1 parts per million (ppm) in swine A and 5.7 (ppm) in swine B. This paper describes two cases of spinal cord and brainstem demyelination due to copper deficiency in piglets.