Establishing normative physiological values among breastfeeding infants in Malawi for the development of a pneumonia dysphagia risk score.

Abstract

Background: Pneumonia is the leading infectious cause of death in children under 5 years of age in low- and middle-income countries (LMICs), with most deaths among infants. In children with pneumonia, aspiration events have been implicated in fatalities; however, physiological data on normative infant feeding patterns and validated techniques for detecting dysphagia and aspiration risk in LMICs are lacking. We aimed to establish a baseline of normative physiological and behavioural feeding-related variables in healthy, well, breastfeeding infants in Malawi to begin developing dysphagia risk scoring tools for infants with severe pneumonia.

Methods: We enrolled healthy breastfeeding infants (<12 months) without known dysphagia risk factors who presented to a vaccination clinic in Lilongwe, Malawi. We incorporated key variables from the literature and expert opinion to create a feeding evaluation protocol. We collected sociodemographic and clinical information and evaluated infants during 5 minutes of breastfeeding. Descriptive statistics and distributions of feeding variables were used to develop two dysphagia risk scoring tools for predicting wet breath sounds during feeding, a proxy for increased aspiration risk. We assessed initial tool performance by calculating test statistics.

Results: We enrolled 100 infants and analysed data from 95 healthy, well participants. The median age was 4 months (IQR 1-6) and 60% (57/95) were female. During feeding, 55% (52/95) had more than one wet breath sound and 17% (16/95) had more than one cough. The two scoring tools classified 2.1% (2/95) and 3.2% (3/95) of participants as 'at risk' for dysphagia. The specificity of each scoring tool was 100% in detecting wet breath sounds during feeding.

Conclusion: We demonstrated that healthy, well Malawian infants exhibit variable vital signs and feeding behaviours during breastfeeding, and these data can be used to develop dysphagia risk scoring tools. Our next steps include evaluating and refining the tools to predict wet breath sounds in infants with severe pneumonia.