Feeding Infants on Noninvasive Respiratory Support: Practice at One Academic Medical Center

Infants requiring noninvasive respiratory support (NRS) are often orally fed, although data supporting the safety and efficacy of this practice are limited. This study aimed to identify the rate of this practice, the amount of support received during oral feeding, and characteristics of infants orally fed during NRS use; describe feeding expert involvement; and assess change from before and after the onset of the COVID-19 pandemic.

Retrospective electronic health record data from one children's hospital were extracted and manually reviewed.

Results for 201 infants who required NRS during hospitalization in 2019 (n = 100) and 2022 (n = 101) were included, of which 91 (45.3%) were orally fed during NRS use. Of these, 33 were fed on high-flow nasal cannula (HFNC) with a mean flow rate of 2.75 L per minute (SD = 2.2, Mdn = 2 [min-max: 2-14]) and mean fraction of inspired oxygen (FiO₂) of 0.47 (SD = 0.31, Mdn = 0.30 [min-max: 0.21-1.0]). Thirty-seven feeding specialist consults were placed for infants fed during NRS use. Factors increasing odds of oral feeding during NRS use included not having a dysphagia or feeding difficulty diagnosis. Infants admitted during 2022 were more likely to have a respiratory diagnosis than in 2019 and were more likely to be orally fed during HFNC (50.0% [n = 25/50] in 2022 vs. 20.5% [n = 8/39] in 2019).

These results suggest that feeding infants on NRS is common, that some infants are more likely to be orally fed than others, and that feeding experts are rarely consulted in this population despite limited safety and efficacy data related to this practice.