A Service Review on Speech Therapy for Patients with Congenital Heart Diseases at Queen Mary Hospital

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Authors (including presenting author) :
Chan CCS(1), Wong KR(2)
Affiliation :
(1) Speech Therapy Unit, Hong Kong Children’s Hospital (2) Department of Speech Therapy, Queen Mary Hospital
Introduction :
Having feeding and swallowing problem is one of the factors impacting congenital heart diseases (CHD) patients’ recovery post cardiac operation. At the same time, CHD patients also have a higher risk of glottic incompetence post operation which leads to poor airway protection during swallow. The speech therapists take a major role in providing swallowing management to CHD patients so as to maximize the safety and efficiency in their oral intake.
Objectives :
This paper aims to review the swallowing management service provided for the CHD patients. In addition, we hope to identify any potential group of patients having higher risk of voice problem post cardiac operation.
Methodology :
Cases referred to speech therapy service from paediatric cardiology specialty at QMH during Apr 2016 to Mar 2018 were reviewed.
Result & Outcome :
The speech therapy discharge summary of 69 cases were reviewed. Among the 69 cases, 33 were male. The age at referral ranged from 1 day to 16 years old, and among them, 56 were aged below 18 months old. Nearly half of them were preterm. All of them were referred for swallowing management. 83% (57) of patients experienced some feeding / swallowing issue. 49 of them presented with dysphagia symptoms and 6 of them have behavioural feeding problem. Two of them having both. Of those dysphagic patients, only 25% of them had oromotor dysfunction component on top of the pharyngeal dysphagia symptoms. Suck-swallow-breath incoordination (40%) and fair endurance (21%) were commonly seen in this group of patients. With therapy given, compensatory strategies suggested and carer education provided, only 5 of them remained non-oral feeding upon discharge who were being followed up in various settings. Besides swallowing issue, 11 patients experienced voice disorder. Although the mean length of intubation for the dysphonic group (10.5 days) is longer than the non-dysphonic group (6.3 days), Mann-Whitney U test showed insignificant difference (p=0.801). The service review demonstrated the high incidence of pharyngeal dysphagia among referred CHD cases. Early speech therapy intervention to maintain or resume safe oral feeding is stipulated. Further investigation is warranted to identify the factor(s) associates with post-op voice disorder.

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