Fiberoptic Endoscopic Assessment of post- extubation palatopharyngeal incoordination in term neonates: Incidence and Risk Factors

Background: Neonates recovering from mechanical ventilation often experience swallowing dysfunctions, including palatopharyngeal incoordination (PPI), a condition underrecognized in full-term infants. PPI can lead to aspiration, recurrent infections, and prolonged hospitalizations. Current literature mainly focuses on preterm infants, leaving a critical knowledge gap regarding term neonates. Objective: To determine the incidence of post-extubation palatopharyngeal incoordination (PPI) in full-term neonates and to identify associated risk factors using Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in resource-limited neonatal intensive care settings. Methods: This cross-sectional study was conducted in two NICUs in Cairo, Egypt, over six months in 2024. Forty full-term neonates with no prior dysphagia, who had been mechanically ventilated, were enrolled. Detailed clinical, laboratory, radiological, and endoscopic assessments were conducted post-extubation. Swallowing function was assessed using FEES. Statistical analysis included logistic regression to identify risk factors associated with PPI. Results: Out of 40 neonates, 80% exhibited clinical signs of swallowing dysfunction; FEES confirmed PPI in 62.5% of these cases. Significant risk factors included prolonged intubation (>8 days, OR=11.0), delayed initiation of intubation (>4 days postnatal age, OR=21.0), positive CRP (>6 mg/L, OR=7.7), positive blood cultures (OR=4.8), low arterial pH (≤7.36, OR=7.1), and elevated PCO₂ (>41 mmHg, OR=8.3). Fentanyl administration was found to be a protective factor (OR=0.16). Longer hospital stays and systemic inflammation were also associated with increased risk. Conclusions: Palatopharyngeal incoordination is highly prevalent among full-term neonates following mechanical ventilation. Prolonged intubation, systemic inflammation, and metabolic derangements are key risk factors. FEES serves as a valuable diagnostic tool for early identification. The protective role of fentanyl warrants further investigation. Early recognition and targeted interventions may improve neonatal outcomes.