Swallowing evaluation in infants with congenital heart disease and Down syndrome : clinical study cases

This study had the aim to perform clinical swallowing evaluation in infants diagnosed with Down syndrome and congenital heart disease (complete atrioventricular canal) suspected to have swallowing disorders hospitalized in unit 2A and Pediatric ICU of instituition.It is a descriptive and qualitative study in which was possible to assess two infants during the proposed period. It was used a sample profile protocol to collect data about clinical history and diagnoses from patients records and the Instrumento de avaliação para prontidão do prematuro para alimentação oral by Fujinaga (2002) for clinical swallowing evaluation. The pacients presented results of oropharyngeal dysphagia and low scores invalidating exclusively oral feed. The treatment was oral stimulation and oral feeding volume controlled. The findings contribute to the literature regarding the correlation between dysphagia, congenital heart defects, genetic syndromes and myofunctional disorders. It is concluded that dysphagia was presented as a difficulty symptom to safe and effective oral feed for all infants studied. Prospective larger researches are needed to contribute with this clinical cases study and thus identify other risk factors for dysphagia and specific treatment for children with Down syndrome and swallowing disorders associated.

本研究旨在对收治于某医疗机构2A病房及儿科重症监护室（Pediatric ICU）、疑似存在吞咽障碍的唐氏综合征（Down syndrome）合并完全性房室间隔缺损（complete atrioventricular canal）先天性心脏病的婴儿开展临床吞咽功能评估。本研究为描述性定性研究，在预设周期内共评估了2名婴儿。研究采用样本概况方案采集患者病历中的临床病史与诊断信息，并使用藤永（Fujinaga）2002年编制的《早产儿口腔喂养准备度评估工具》（Instrumento de avaliação para prontidão do prematuro para alimentação oral）开展临床吞咽功能评估。受试婴儿均表现出口咽吞咽困难（oropharyngeal dysphagia）症状，且评分偏低，无法仅通过口腔进食实现安全有效的营养供给。干预方案为口腔刺激与口腔喂养量管控。本研究结果可为吞咽障碍、先天性心脏缺陷、遗传综合征与肌功能障碍之间的相关性研究提供文献参考。综上，本次纳入研究的所有婴儿均存在吞咽困难症状，难以安全有效地开展口腔进食。未来需开展更大样本量的前瞻性研究，以进一步丰富此类临床病例研究，并明确唐氏综合征合并相关吞咽障碍患儿的其他吞咽障碍风险因素与针对性治疗方案。