OUTCOMES FOR INFANTS WITH BRIEF RESOLVED UNEXPLAINED EVENT (BRUE) DIAGNOSED WITH OROPHARYNGEAL DYSPHAGIA OR GASTROESOPHAGEAL REFLUX: A MULTICENTER STUDY FROM THE PEDIATRIC HEALTH INFORMATION SYSTEM (PHIS) DATABASE

Background: Despite data suggesting that oropharyngeal dysphagia may be a cause of brief resolved unexplained event (BRUE), clinicians continue to attribute these events to gastroesophageal reflux disease (GERD). The current literature is limited to single center studies or multicenter studies that do not address oropharyngeal dysphagia as a cause. The aim of this study was, using a large multicenter pediatric database, to determine the prevalence of GERD and oropharyngeal dysphagia explanatory diagnoses, acid suppression treatment, and risk factors for repeat hospital visit after BRUE.

Methods: We conducted a multicenter retrospective cohort study of infants admitted with BRUE to one of the 52 hospitals included in the Pediatric Health Information System (PHIS) database. Data collected from the PHIS database included evaluations for GERD/oropharyngeal dysphagia with performance of bedside clinical feeding evaluations (CFE) and videofluoroscopic swallow studies (VFSS), treatment with acid suppression, and repeat hospital visits for related reasons occurring within 6 months of the index hospitalization. Multivariable logistic regression models were used to determine risk factors for repeat hospital visit.

Results: Of 17,558 subjects admitted to 49 hospitals, 34% (5,933) were given an explanatory diagnosis of GERD and 1.4% (238) oropharyngeal dysphagia. Twelve percent (2,169) of all patients were treated with acid suppression, with some centers having prescribing rates as high as 26% as shown in the figure. Three thousand ninety-five subjects, representing 19% of the cohort, underwent CFE and 413 (2.4%) underwent VFSS. Ten percent (1,681) of subjects had repeat hospital visits. Risks factors for repeat hospital visit are shown in the table. Subjects given an explanatory diagnosis of GERD or oropharyngeal dysphagia had increased risk for repeat hospital visits as did those treated with acid suppression and those that underwent CFE. In contrast, those that underwent VFSS to provide objective, directed therapy for oropharyngeal dysphagia were not at increased risk.

Conclusions: GERD as an explanatory diagnosis was associated with increased risk of repeat hospital visit, despite its conception as a benign, treatable condition. Treatment with acid suppression was common but this did not prevent repeat hospitalization. While clinical feeding evaluations alone were not helpful, VFSS performance may reduce repeat hospitalization risk. Consideration of oropharyngeal dysphagia in addition to or instead of GERD might be beneficial in infants with BRUE.