Response to de Groot et al.

Abstract

We thank de Groot et al. [1] for their interest in and feedback on our recent article [2] and for the opportunity to clear up any confusion. Our team agrees with the importance of the clinical bedside assessment and intervention attempts as well as only recommending instrumental assessments when necessary for diagnostic or management purposes [3]. As we described in the discussion section, our comprehensive feeding evaluation begins with a clinical bedside assessment and consultation with the feeding team [2]. Based on the observational findings, compensatory strategies are attempted [4]. Only if the infant continues to demonstrate signs of oropharyngeal dysphagia despite these interventions, and the feeding team determines that an instrumental assessment is medically necessary for appropriate management, does the physician order the instrumental assessment. For the purposes of our research, it was at this time that infants became eligible for study inclusion. Because our research aims were to evaluate FEES and VFSS, the findings from clinical bedside assessments and attempted treatment strategies, while certainly considered in patient management, were outside the scope of the study and were therefore not reported [2, 5]. We also agree that instrumental assessments do not address all of the skills required for oral feeding, and we do not advocate for their indiscriminate use. In our NICU, we perform instrumental assessments on only a small proportion of the infants. Since FEES became a standard of care in our NICU 6 years ago, between 3 and 4% of the infants admitted to the NICU have been evaluated using an instrumental swallowing assessment. We attribute this rate to the success of the feeding team in being able to implement appropriate feeding strategies based on the observational findings of the clinical bedside assessment. Finally, we concur with the statement that NICU infants are not a homogeneous population in the way their oral feeding develops. We were referring to the homogeneity of the anatomical structures and swallowing physiology within a group of young infants when contrasting our study with previous studies and their heterogeneous participants of young infants and older children or adults. Our argument was that because the anatomy and physiology of the swallow is different between young infants and older children/adults, instrumental assessment findings pertaining the latter could not automatically be applied to the former.