Fellow Physician John H Stroger hospital of Cook County Health Chicago, Illinois, United States
Background: Non-invasive respiratory support (NIV) reduces lung injury from invasive ventilation, but pressurized gases in NIV may lead to bowel distension, affecting feeding. This challenge, combined with respiratory distress, complicates timely enteral nutrition establishment, requiring extended parenteral nutrition and hospital stays. Preterm infants often start feeding via a gastric tube, continuously or intermittently. Bolus feeding triggers hormonal surges, but continuous feeds cause fewer issues. However due to premature infants' digestive limitations, like delayed gastric emptying, hinder their ability to handle bolus feeds, leading to feeding intolerance. There's a lack of conclusive evidence supporting specific oral feeding during NIV, emphasizing the need for standardized approaches among clinicians initiating oral feeds in these cases. Objective: To evaluate the duration for preterm infants on NIV support (RAM cannula - short binasal prongs) to achieve full feeds, while comparing continuous and bolus feeding method. Design/Methods: Randomized controlled trial conducted in a tertiary NICU focuses on preterm infants, born at less than 34 weeks gestation and receiving NIV. The recruitment goal is 46 infants, currently 23 infants are enrolled. The preliminary analysis is being conducted on these 23 infants. These infants are randomly allocated to either continuous or bolus feeding groups (sub-stratified as per weight < 1000 g, 1000-1500 g, >1500 g), with feeding procedures and complication monitoring adhering to NICU protocols. The study is IRB approved and applies an intention-to-treat protocol. Statistical analysis will be performed using SAS 9.4. Survival analysis is performed to assess the time to achieve full feed status in preterm infants. Kaplan-Meier survival curves is constructed for continuous and bolus feed groups. The log-rank test is conducted to compare time-to-event differences between groups, using a significance level of p < 0.05. Cox proportional-hazards regression analysis is done to account for additional factors.
