424 - Early Premature Infants on Respiratory Support: A Functional Early Enteral Development (FEED) Randomized Control Trial

Poster Number: 424
Publication Number: 424.223

Ashley Morin, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Allison Davidson, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Wen Li, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Suzanne Lopez, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States

Background: Achieving full oral feedings is often delayed in early preterm infants requiring respiratory support. A quality improvement study demonstrated oral feeding while on nasal continuous positive airway pressure (nCPAP) decreased the length of hospitalization in infants with chronic lung disease. A systematic review published in 2021 reported insufficient evidence to support oral feeds while on nCPAP and high flow nasal cannula (HFNC) without further studies.

Objective: To determine if initiation of oral feeds in infants greater than 32 weeks post menstrual age (PMA) requiring nCPAP or HFNC can safely achieve full oral feedings sooner and thereby decrease length of hospitalization.

Design/Methods: A single center randomized controlled trial enrolling infants greater than 32 weeks PMA requiring HFNC > 2 LPM or nCPAP < 6 cm H2O FiO2 < 30% for 72 hours or more and tolerating enteral feeds of 120ml/kg/day. The primary outcome measured was PMA an infant achieved full oral feedings. The secondary outcomes measured were PMA an infant completed a first oral feed, length of hospitalization, PMA at hospital discharge, gastrostomy tube (GT) placement, oxygen at discharge and aspiration pneumonia diagnosis during study participation. Infants meeting inclusion criteria were randomized to either the oral feed intervention group (OFG) or usual care group (UCG) at a one-to-one ratio within two strata of respiratory support and gestational age with variable block size. The infants enrolled in the OFG were evaluated by occupational therapy utilizing an established oral feeding advancement protocol. A sample size of 58 patients is needed to achieve a statistically significant 2-week difference.

Results: Of 92 patients meeting inclusion criteria, 28 patients were consented and enrolled to participate. Results are on completed data on 22 subjects (11 OFG (50%) vs 11 UCG (50%)). The mean PMA at full oral feeds (OFG 38.5 weeks (SD 2.6) vs. UCG 38.3 weeks (SD 2)), mean PMA at completion of first oral feed (OFG 37.4 weeks (SD 2.8) vs. UCG 36.5 weeks (SD 2.9)), mean PMA at discharge (OFG 40.9 weeks (SD 4.5) vs UCG 40.6 weeks (SD 3.7) were similar. The mean length of hospitalization was slightly less in OFG 94.1 days (SD 29.4) compared to UCG 95.7 days (SD 33.3). One infant in each group required a GT and did not achieve full oral feeds.Conclusion(s): There is no significant difference in PMA at full oral feeds and PMA at discharge between the OFG and UCG. Further secondary analysis is currently ongoing such as frequentist and bayesian analysis to determine differences between groups and probability of benefit of the intervention.