Objective: To determine the effect of nipple feeding and 2 methods of gavage feeding, on apnea, bradycardia and desaturation frequency. Patients: 30 preterm infants breathing room air; GA 28.6±2.1 wk at birth and 34.0±1.4 wk at study. Methods: 9 h recordings of pulse oximeter saturation (SpO2), pulse waveforms, ECG, breathing movements and nasal airflow. Administration of 21±1.5 ml/kg of milk in 3 h intervals using 3 different feeding techniques in random order: nipple feeding, bolus gavage feeding, and slow gavage feeding (1 h). Analysis of recordings for apneas (>4 s), bradycardias (heart rate <2/3 of baseline), and episodic desaturation (SpO2 ≤80%).Results: There were 3 times more desaturations with nipple feeding than with bolus gavage feeding (p<0.001), but no further reduction with slow gavage feeding. With all 3 feeding techniques, there were significantly more desaturations during the hour the feedings were given than during the following 2 hours. The deleterious effects of nipple feeding became most evident during the hour of feeding, but desaturation frequency still remained significantly higher than with gavage feeding during the following 2 hours. There was no significant effect of feeding technique on the frequency of apnea or bradycardia. Conclusions: Preterm infants who are normally oxygenated in room air may have significant desaturation during nipple feeding. The latter can be effectively reduced by gavage feeding. Slow gavage feeding offers no advantage over bolus gavage feeding.
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