Researchers Find Better Diagnosis Method for NICU Babies with Feeding Problems

New study proves safety and reliability of swallowing assessment for premature newborns

A new study conducted at Baylor University Medical Center at Dallas is the first-ever to prove the safety and reliability of an innovative swallowing assessment method for infants in the neonatal intensive care unit (NICU). The study, recently published in the Journal of Perinatology, used Fiberoptic Endoscopic Evaluation of Swallowing (FEES) technology to better diagnose feeding problems in the hospital's tiniest patients, giving new moms more confidence to feed their newborn safely. Generous donor support to Baylor Health Care System Foundation fully funded the groundbreaking research and necessary equipment purchases.

"We're proud to be the first institution to publish information on this evaluation with babies who show problems with bottle feeding," said Mustafa Suterwala, MD, pediatrician on the medical staff at Baylor University Medical Center and co-author of the study, which was conducted through the Baylor Scott & White Research Institute. "Once a mother is aware her infant can't tolerate thin liquids through a bottle, she becomes scared to feed. Our evaluation method offers her peace of mind and reassurance."

Many babies born prematurely have difficulty with coordination of sucking, swallowing and breathing required to feed safely. Traditionally, caregivers would pinpoint the problem by taking an X-ray and recording a short video snapshot of the baby swallowing while feeding – called Videofluroscopy Swallow Study (VFSS) – though the assessment has limitations. The baby must be transported to radiology, exposed to radiation and then evaluated for a short period of time in an unnatural feeding environment.  It also can only be done while the infant is bottle feeding and can't assess if breastfeeding is safe.

To better assess swallowing problems, the NICU at Baylor University Medical Center is one of a few nationwide implementing FEES, which inserts a tiny fiberoptic scope with a camera into the baby's nose while they're bottle feeding or breastfeeding. Dr. Suterwala and a team of neonatal therapists, Sandra Carroll, Chrysty Sturdivant, and Jenny Reynolds, developed the unique assessment, which allows neonatal speech pathologists to visualize the baby's swallowing mechanism and function in real time during an entire 20-minute feeding and simulate a more natural feeding environment because it can be performed at the bedside.

For this research study, 25 infants at least 37 weeks old were assessed with both FEES and VFSS. Results showed FEES is as safe and reliable as VFSS, while providing more information for the neonatologist and the rest of the care team to make the most appropriate clinical decisions for the infant. The method also allows the family to observe the evaluation and receive parent education simultaneously. The findings and eventual incorporation of FEES into neonatal care are groundbreaking.

"We hope to empower the mother with this assessment, providing a safe feeding plan for home and helping her feel more confident and competent, which can help minimize mom's anxiety and help with the baby's development," said Jenny Reynolds, speech pathologist and neonatal therapist at Baylor University Medical Center and co-author of the study.

Study participant Sharon Alsobrook's newborn son, Teddy, was aspirating while bottle feeding. Doctors were concerned about breastfeeding because they were not able to prove that it would be a safe feeding method. The medical team and neonatal therapist recommended enrolling Teddy in the study for the FEES assessment.

"Teddy latched on and started breastfeeding, and then they put the scope up his nose and fed it down to the top of the throat while he was swallowing," Alsobrook said. "He wasn't feeding perfectly normal during breastfeeding, but we found a position where he was able to do it safely. The FEES study was the only reason I was able to breastfeed at all. I would have completely just stopped breastfeeding."

Megan Jacob

About Baylor Scott & White Health
As the largest not-for-profit health system in the state of Texas, Baylor Scott & White promotes the health and well-being of every individual, family and community it serves. It is committed to making quality care more accessible, convenient and affordable through its integrated delivery network, which includes the Baylor Scott & White Health Plan, Baylor Scott & White Research Institute, the Baylor Scott & White Quality Alliance and its leading digital health platform – MyBSWHealth. Through 51 hospitals and more than 1,200 access points, including flagship academic medical centers in Dallas, Fort Worth and Temple, the system offers the full continuum of care, from primary to award-winning specialty care. Founded as a Christian ministry of healing more than a century ago, Baylor Scott & White today serves more than three million Texans. For more information, visit: