Establishing an SLT-ENT neonatal inpatient FEES service in the UK: Diagnostic impact on dysphagia and upper airway pathologies

This paper describes a pioneering neonatal SLT-ENT flexible endoscopic evaluation of swallowing (FEES) service delivered jointly by specialist neonatal speech and language therapists (SLT) and paediatric ear, nose and throat (ENT) surgeons. The service assesses swallowing physiology, secretion management and upper airway anatomy for neonates with suspected dysphagia, in whom silent aspiration and airway anomalies are often undetected. This joint SLT-ENT model enabled safe, efficient completion of FEES in a tertiary neonatal unit and facilitated earlier, more accurate diagnosis of dysphagia and previously unrecognised upper airway abnormalities.

Alanna Thompson (née Wagher)
Highly Specialised Speech and Language Therapist
alanna.thompson@stgeorges.nhs.uk

Nicoll Bell
Clinical Lead Neonatal Speech and Language Therapist

St George’s Hospital, London

Thompson A., Bell N. Establishing an SLT-ENT neonatal inpatient FEES service in the UK: Diagnostic impact on dysphagia and upper airway pathologies. Infant 2025; 21(6): 179-81.

Full text available by subscription ...

The full text of this article is available to subscribers in text, and in Tablet/iPad format and as a PDF file.

Please subscribe and log in to see the full article.

Keywords

neonatal dysphagia; infant feeding; FEES (flexible endoscopic evaluation of swallowing); ENT (ear, nose and throat); laryngomalacia

Key points

Paediatric ENT involvement is essential for safe scope insertion and accurate diagnosis of upper airway anomalies.
FEES provides objective detection of dysphagia and silent aspiration.
Laryngomalacia was commonly identified in neonates with feeding difficulties despite absent stridor, consistent with evidence that mild forms of laryngomalacia can significantly impact feeding.
Establishing neonatal FEES services requires specialist training from FEES-competent neonatal SLTs and paediatric ENTs – a logistical barrier given the lack of UK-based neonatal FEES training.

Also published in Infant:

VOLUME 21 ISSUE 2/APRIL 2025

Use of FEES in identifying neurological variant of laryngomalacia, dysphagia and subsequent Smith-Magenis syndrome diagnosis in a newborn

The authors present a single patient case study of a term infant presenting with marked tachypnoea and desaturations of unknown cause while breastfeeding immediately following birth. Specialised speech and language therapy assessments, including fibreoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallow study (VFSS), helped to identify a neurological variant of dysphagia, resulting in further neurological and genetic testing, and the positive identification of Smith-Magenis syndrome.