Abstract
BackgroundThe aim of this systematic review was to determine whether introduction of oral feeding for infants and children receiving nasal continuous positive airway pressure (nCPAP) or high flow nasal cannula (HFNC) respiratory support facilitates achievement of full oral feeding without adverse effects, compared to no oral feeding (NPO; nil per oral) on CPAP or HFNC.MethodsA protocol was lodged with the PROSPERO International Prospective Register of Systematic Reviews. We searched Medline, Embase, CINAHL, CENTRAL and AustHealth from database inception to 10th June 2020. Study population included children (preterm to < 18 years) on nCPAP or HFNC who were orally feeding. Primary outcomes included full or partial oral feeding and oropharyngeal aspiration. Secondary outcomes examined adverse events including clinical signs of aspiration, aspiration pneumonia and deterioration in respiratory status.ResultsThe search retrieved 1684 studies following duplicate removal. Title and abstract screening identified 70 studies for full text screening and of these, 16 were included in the review for data extraction. Methods of non-invasive ventilation (NIV) included nCPAP (n = 6), nCPAP and HFNC (n = 5) and HFNC (n = 5). A metanalysis was not possible as respiratory modes and cohorts were not comparable. Eleven studies reported on adverse events. Oral feeding safety was predominantly based on retrospective data from chart entries and clinical signs, with only one study using an instrumental swallow evaluation (VFSS) to determine aspiration status.ConclusionsFindings are insufficient to conclude whether commencing oral feeding whilst on nCPAP or HFNC facilitates transition to full oral feeding without adverse effects, including oropharyngeal aspiration. Further research is required to determine the safety and efficacy of oral feeding on CPAP and HFNC for infants and children.Trial registrationPROSPERO registration number: CRD42016039325.
Highlights
The aim of this systematic review was to determine whether introduction of oral feeding for infants and children receiving nasal continuous positive airway pressure or high flow nasal cannula (HFNC) respiratory support facilitates achievement of full oral feeding without adverse effects, compared to no oral feeding (NPO; nil per oral) on CPAP or HFNC
Hanin [26] found that infants who initiated oral feeding while on CPAP achieved oral feeding milestones at an earlier postmenstrual age (PMA), Dumpa [24] reported no significant difference and LaTuga [34] reported that infants who started oral feeding on CPAP took longer to attain full oral feeding
Bapat [23] reported on duration to full oral feeding for preterm infants with bronchopulmonary dysplasia (BPD) who participated in a quality improvement project to enhance feeding milestones and found that infants with mild to moderate BPD achieved full oral feeds earlier on their SIMPLE feeding program vs baseline group (p < 0.05)
Summary
The aim of this systematic review was to determine whether introduction of oral feeding for infants and children receiving nasal continuous positive airway pressure (nCPAP) or high flow nasal cannula (HFNC) respiratory support facilitates achievement of full oral feeding without adverse effects, compared to no oral feeding (NPO; nil per oral) on CPAP or HFNC. The use of non-invasive ventilation (NIV), including nasal continuous positive airway pressure (nCPAP) and high flow nasal cannula (HFNC), has increased over the last two decades as primary or step-down respiratory therapies for infants and children with acute and chronic respiratory conditions [1,2,3]. They provide support for infants in neonatal intensive care units (NICU) with respiratory distress syndrome and bronchopulmonary dysplasia (BPD)/chronic neonatal lung disease (CNLD) [1, 4], and children in pediatric intensive care units (PICU) for treatment of acute illnesses such as bronchiolitis and pneumonia; and can reduce the need for invasive ventilation [5, 6]. Potential aspiration during oral feeding whilst receiving nCPAP and HFNC could increase the duration of respiratory support requirement, increase hospital length of stay and negatively impact feeding and respiratory outcomes
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