Episode 86: Infant FEES in the Neonatal Intensive Care Unit with Raquel Garcia, SLPD, CCC-SLP, CNT, BCS-S

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) has been an instrumental tool used in adult intensive care units for many years. Adult intensivists have had education, training, and exposure to FEES to assess oropharyngeal physiology and direct appropriate treatment plans. Pediatric intensivists and neonatologists have had limited exposure to FEES and typically use videofluroscopic swallow studies (VFSS) as the gold standard for assessing dysphagia in infants. The purpose of this presentation is to review the role of FEES in a level three neonatal intensive care unit (NICU) and pediatric cardiac intensive care unit (PCVICU) Physician perceptions and education/training provided to the critical care nurse will be discussed at length, including an online survey that was completed by pediatric intensivists, neonatologists, and nurses about the role of FEES and safety of FEES with infants.

topics covered:

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  • Brief overview of feeding in critical care units (i.e. NICU)

  • Overview of FEES

  • Differences between FEES and VFSS

  • Inclusion/Exclusion Criteria, Benefits of Infant FEES


Resources mentioned in the episode:

Journal Articles:

Suterwala MS, Reynolds J, Carroll S, Sturdivant C, Armstrong ES. Using fiberoptic endoscopic evaluation of swallowing to detect laryngeal penetration and aspiration in infants in the neonatal intensive care unit. J Perinatol. 2017;37(4):404-408. doi:10.1038/jp.2016.239

Armstrong ES, Reynolds J, Carroll S, Sturdivant C, Suterwala MS. Comparing videofluoroscopy and endoscopy to assess swallowing in bottle-fed young infants in the neonatal intensive care unit. J Perinatol. 2019;39(9):1249-1256. doi:10.1038/s41372-019-0438-2

Vetter-Laracy S, Osona B, Roca A, Peña-Zarza JA, Gil JA, Figuerola J. Neonatal swallowing assessment using fiberoptic endoscopic evaluation of swallowing (FEES). Pediatr Pulmonol. 2018;53(4):437-442. doi:10.1002/ppul.23946

Willette, Susan & Molinaro, Laura & Thompson, Dana & Schroeder, James. (2015). Fiberoptic Examination of Swallowing in the Breastfeeding Infant. The Laryngoscope. 126. 10.1002/lary.25641.


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Raquel Garcia is a trained craniofacial speech-language pathologist who is a core member of the Joe DiMaggio Children's Hospital Craniofacial team. She works in the acute care setting in the Neonatal Intensive Care Unit and Pediatric Cardiac Intensive Care Unit. She graduated with her M.S. in communication disorders from Nova Southeastern University and her doctorate of speech-language pathology from Northwestern University. Her clinical interests include velopharyngeal dysfunction, upper airway disorders, infant feeding, neonatal care, neuroanatomy, and dysphagia.


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