Study population
This was a retrospective single-center cohort study of children referred
for VFSS at Schneider Children’s Medical Center of Israel (SCMCI), a
tertiary pediatric hospital. Included were all children who successfully
completed a VFSS between the ages of 0-18 years between the years 2011
and 2017. Excluded were children who failed performing the VFSS
technically or due to lack of co-operation. The study was approved by
the local Institutional Review Board, number 0516-17-RMC.
Medical records were reviewed for diagnoses and coded for chiefly
affected organ systems using a modified version of that described by
Burklow et al9 which includes structural
abnormalities, neurological conditions, behavioral issues,
cardiorespiratory problems and metabolic dysfunction. We did not include
behavioral and metabolic categories. To reflect the high prevalence of
motility issues and genetic syndromes in our population, we added
gastrointestinal and genetic categories. These affected organ systems
were not scored as mutually exclusive. We further grouped patients
according to medical diagnoses of particular interest, again not
mutually exclusive, including Down’s syndrome, cerebral palsy,
developmental delay, tracheo-esophageal fistula, congenital heart
disease, preterm birth (prior to 37 completed weeks), bronchopulmonary
dysplasia and clinically suspected aspiration lung disease. The latter
included those subjects where a clinical diagnosis of aspiration lung
disease was identified in medical records.