Question
What factors should SLPs review in the NICU chart to anticipate a neonate's feeding challenges?
Answer
Before ever going bedside, the chart review is where we gather all available information about a patient and begin forming our clinical hypothesis. We want to understand why we are being consulted as speech-language pathologists, identify factors that may currently be impacting feeding performance, and determine which materials and supplies to bring to the bedside. A thorough chart review allows us to anticipate what we will see before we even meet the baby, the nurse, and the caregivers.
Several diagnostic categories merit attention during the chart review. Size-related diagnoses include intrauterine growth restriction (IUGR), fetal growth restriction (FGR), and small-for-gestational-age (SGA). Babies in these categories may act more developmentally immature than their post-menstrual age would suggest, because their growth in utero was restricted. Conversely, large for gestational age (LGA) babies may appear to have an advantage, but in my experience, they are often sleepier than their peers, tire easily, and may have reduced tone.
For babies undergoing genetic workup or with metabolic conditions, I recommend searching the specific diagnosis paired with oral feeding to understand whether it is associated with feeding difficulties and whether those difficulties are expected to improve or progress over time. Airway diagnoses include tracheoesophageal fistula (TEF), laryngomalacia, and subglottic stenosis. Craniofacial diagnoses such as cleft lip, cleft palate, and Pierre Robin sequence affect the anatomical structures required for feeding and require specific adaptive equipment and management pathways.
This Ask the Expert is an edited excerpt from the course, Navigating the NICU Chart Review, presented by Nicole Scafura, M.S., CCC-SLP, CNT.
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