Changing oxygenation strategies not associated with differences in feeding intolerance in preterm infants

1. In preterm infants with respiratory distress, there was no difference in time to full enteral feeding (FEF), between the nasal continuous positive airway pressure (NCPAP) and heated humidified high-flow nasal cannula (HHHFNC) groups.

2. The NCPAP group had a lower rate of ineffectiveness than the HHHFNC in treating respiratory distress syndrome (RDS)

Evidence Rating Level: 1 (Evidence)

RDS is common in preterm infants, and noninvasive respiratory support (NRS) modalities like NCPAP and HHHFNC are employed to mitigate adverse events in these infants. While preterm infants benefit from early initiation of enteral feeding, many experience feeding intolerance. The pressurized gas flow, gaseous distension of the intestine, and the oxygen-enriched air mixture associated with NRS may affect feeding intolerance in preterm infants. Therefore, this multicenter randomized control trial aimed to compare the effects of NCPAP and HHHFNC on feeding intolerance in preterm infants with RDS. 247 infants (median [IQR] gestational age 28 [27-29] weeks, 52.6% female) born between November 2018 and June 2021, diagnosed with RDS, and who passed stability testing, were randomized to either HHHFNC (n=122) or NCPAP (n=125). The median time to reach FEF was 14 days  (95% CI, 11-15 days) in the NCPAP group, which was not significantly different than 14 days (95% CI, 12-18 days) in the HHHFNC group at (p=0.85). Furthermore, between the two groups, there were no significant differences in secondary nutritional outcomes—no difference in weight growth, feeding interruption, feeding interruption lasting more than 24 hours, pathological gastric residual volume, frequent vomiting or regurgitation, and abdominal distension. Between randomization and time to reach FEF, 68.0% of infants in the NCPAP group and 60.8% in the HHHFNC group changed or discontinued their assigned NRS. The NCPAP group had a lower proportion of patients switching due to treatment ineffectiveness compared to the HHHFNC group  (4.8% vs. 73.9%, p<0.001). Additionally, at the time of the first change, the NCPAP group showed a higher median  SpO2–FIO2 ratio compared to the HHHFNC group (p < .001). Overall, this study found that feeding intolerance did not significantly differ between preterm infants in the NCPAP and HHHFNC groups, but some short-term respiratory outcomes were better with NCPAP.

Click to read the study in JAMA Network Open

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