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

Abstract

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 aero-digestive outcomes and reduces resource utilization. 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. 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) versus 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. Controlled introduction of oral feedings in infants with BPD during NCPAP is safe and may accelerate the acquisition of oral feeding milestones.

Conflict of interest statement

Conflict of Interest: The authors declare that they have no conflict of interest.

Figures

Figure 1. Full oral feeding milestones in NCPAP-oral fed group (n=20) vs NCPAP-gavage fed group (n=17)

A. NCPAP-oral fed group achieved oral feeding milestone at earlier chronologic age than NCPAP-gavage fed group. B. Though the GA at birth was similar in two groups, NCPAP-oral fed group achieved oral feeding milestones at earlier PMA than NCPAP-gavage fed group.

Figure 2. Resource utilization in NCPAP-oral fed group vs. NCPAP-gavage fed group

A. NCPAP-oral fed group had similar length of hospital stay than NCPAP-gavage fed group. B. Readmission rate 30 days post discharge was similar in NCPAP-oral fed group than NCPAP-gavage fed group.