Safety and Efficacy of Oral Feeding in Infants with BPD on Nasal CPAP

Abstract

Objective Safety and efficacy of oral feeding was examined in infants with bronchopulmonary dysplasia (BPD) on nasal continuous positive airway pressure (NCPAP). We hypothesized that repetitive oral feeding enhances aerodigestive outcomes and reduces resource utilization. Methods Data from infants with BPD (37–42 weeks post menstrual age) that were orally fed while on NCPAP (n=26) were compared with those that were exclusively gavage fed on NCPAP (n=27). Subject assignment was random and physician practice based. Specifically, we compared the differences in aero-digestive milestones, resource utilization and safety metrics. Results Demographic characteristics such as gender distribution, gestational age and birth weight, clinical characteristics such as frequency of intraventricular hemorrhage and patent ductus arteriosus needing surgical ligation were similar in both groups (p > 0.05). Characteristics of respiratory support and airway milestones were similar in both groups (p > 0.05). However, infants in NCPAP-oral fed group had earlier acquisition of full oral feeding milestone by 17 days (median) vs. infants who were not orally fed during NCPAP (p < 0.05). Discharge weights and the frequency of gastrostomy tube placement were also similar in both groups (p > 0.05). There were no tracheostomies in either group. There was no incidence of clinically significant aspiration pneumonia in infants during the period of the oral feeding while on NCPAP. Conclusion Controlled introduction of oral feedings in infants with BPD during NCPAP is safe and may accelerate the acquisition of oral feeding milestones.

Effect of nasal noninvasive respiratory support methods on pharyngeal provocation-induced aerodigestive reflexes in infants

“…Further studies are therefore warranted to clarify these observations. Indeed, although this is a new approach and represents a change in practice, since oral feeding is controversial in this group, we have recently shown in a pilot study the safety and feasibility of feeding infants cautiously while on nCPAP (7). Given the response to targeted pharyngeal provocation, we believe that infants have the ability to protect and clear the bolus with appropriate proximal peristaltic mechanisms, even under the studied conditions of nasal CPAP.…”

High flow nasal cannula versus NCPAP, duration to full oral feeds in preterm infants: a randomised controlled trial

“…Oral feeding is usually trialled in infants older than 32 weeks corrected gestational age (CGA), when they have developed the coordination for sucking, swallowing and breathing. Many clinicians wait until after infants are off NCPAP support before offering oral feeds 8 9. Time to achieve full oral feeds was reported as a secondary outcome in the RCT by Yoder et al 10.…”

Brain Lesions among Orally Fed and Gastrostomy-Fed Dysphagic Preterm Infants: Can Routine Qualitative or Volumetric Quantitative Magnetic Resonance Imaging Predict Feeding Outcomes?

“…We speculate that these practices may have accelerated the favorable synaptogenesis vs. favorable synaptic pruning relationships in these regions. In contrast, G-tube fed infants have less oral feeding opportunities and oral stimulation may, limitedly, happen during salivation or gastroesophageal reflux events (12–16). …”

“…Infants discharged with a G-tube will have a long-term morbidity risk related to enteral tubes, compared to orally fed infants. G-tube may also result in an aversion to feeding and increased hospital admittance, which will lead to socioeconomic burdens on families and society (12–16). Sensitive tools that can early identify brain anatomical changes and predict subsequent neurodevelopmental disability are crucially important for early intervention and amelioration of potential problems.…”