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A Strategy to Reduce Critical Cardiorespiratory Alarms due to Intermittent Enteral Feeding of Preterm Neonates in
Rohan Joshi1,2, Carola van Pul2,3, Anouk Sanders4
1Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands.
Insights
For premature infants, gravity feeding is safer than push feeding when infants are in the lateral position, reducing critical cardiorespiratory alarms. No difference was found when infants were in the prone position.
Area of Science:
- Neonatal care
- Pediatric gastroenterology
- Infant physiology
Background:
- Preterm infants often require enteral feeding due to difficulties with coordinated sucking, swallowing, and breathing.
- Enteral feeding involves delivering milk via a nasogastric or orogastric tube.
- Current methods include syringe (push) or gravity feeding, with no established preference.
Purpose of the Study:
- To compare the physiological tolerance of push versus gravity enteral feeding in preterm infants.
- To determine which feeding method results in fewer critical cardiorespiratory alarms.
Main Methods:
- An observational study involving 2140 feeding episodes in 25 preterm infants (gestational age < 30 weeks).
- Data collected on infant characteristics, feeding methods (push vs. gravity), infant position, and nursing events.
- Logistic regression with mixed effects was used to analyze the incidence of cardiorespiratory alarms.
Main Results:
- Infant position significantly influenced the outcome of critical alarms (P=.02).
- Push feeding in the lateral position resulted in 40% more critical cardiorespiratory alarms compared to gravity feeding.
- No significant difference in alarms was observed between push and gravity feeding in the prone position.
Conclusions:
- Gravity feeding is recommended over push feeding for preterm infants in the lateral position to minimize cardiorespiratory events.
- Infant positioning is a crucial factor in optimizing enteral feeding protocols.
- Objective data support evidence-based adjustments to neonatal feeding practices.
Background:
Many preterm infants require enteral feeding as they cannot coordinate sucking, swallowing, and breathing. In enteral feeding, milk feeds are delivered through a small feeding tube passed via the nose or mouth into the stomach. Intermittent milk feeds may either be administered using a syringe to gently push milk into the infant's stomach (push feed) or milk can be poured into a syringe attached to the tube and allowed to drip in by gravity (gravity feed). This practice of enteral feeding is common in neonatal intensive care units. There is, however, no evidence in the literature to recommend the use of one method of feeding over the other.
Objective:
The aim of this study was to investigate which of the two methods of feeding is physiologically better tolerated by infants, as measured by the incidence of critical cardiorespiratory alarms during and immediately after feeding.
Methods:
We conducted a prospectively designed observational study with records of all feeding episodes in infants of gestational age less than 30 weeks at birth and with a minimum enteral intake of 100 mL/kg/day. In total, 2140 enteral feeding episodes were noted from 25 infants over 308 infant-days with records for several characteristics of the infants (eg, gestational age), feeding (eg, the position of infants), and of nursing-care events before feeding (eg, diapering). Logistic regression with mixed effects was used to model cardiorespiratory alarms for the push and gravity methods of feeding.
Results:
After adjustments were made for all confounding variables, the position of infants was found to be statistically significant in changing the outcome of critical alarms for the two methods of feeding (P=.02). For infants in the lateral position, push feeds led to 40% more instances of one or more critical cardiorespiratory alarms in comparison with the gravity method. Both methods of feeding created a statistically comparable number of alarms for infants in the prone position.
Conclusions:
This study provides objective data that may assist in optimizing enteral feeding protocols for premature infants. The incidence of critical cardiorespiratory alarms for infants in the lateral position can be lowered by the use of gravity instead of push feeding. No differences were observed between the two types of feeding when infants were in the prone position.
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