Oral Feeding and Aspiration Risk in Preterm Infants Receiving Nasal High-Flow Respiratory Support: A Cross-Sectional...

Area of Science:

• Neonatal care
• Pediatric gastroenterology
• Respiratory therapy

Background:

• Nasal high-flow (NHF) therapy is common in preterm infants.
• Assessing aspiration risk during oral feeding in infants receiving NHF is crucial.
• Current guidelines lack objective data on NHF's impact on aspiration.

Purpose of the Study:

• To objectively evaluate aspiration risk during oral feeding in preterm infants receiving NHF.
• To determine the correlation between NHF flow rate and oropharyngeal aspiration (OPA).
• To correlate NHF parameters with the presence and severity of OPA.

Main Methods:

• Cross-sectional study in a single-center neonatal unit.
• Included preterm infants (gestational age <37 weeks) aged ≥35 weeks corrected gestational age (CGA) undergoing oral feeding trials with NHF (>1 L/min).
• Videofluoroscopic swallow study (VFSS) assessed aspiration using the Penetration-Aspiration Scale (PAS); clinical feeding evaluation (CFE) and flow rates were recorded.

Main Results:

• Twenty preterm infants were studied, with two confirmed cases of silent aspiration on VFSS.
• Aspiration severity (PAS score) was not correlated with unadjusted NHF flow rate (L/min).
• Aspiration severity was significantly inversely correlated with weight-adjusted NHF flow rate (L/kg/min; p=0.01).

Conclusions:

• Oral feeding appears safe for select, clinically stable preterm infants receiving NHF under controlled conditions.
• Aspiration risk assessment should prioritize patient-specific factors over solely relying on NHF use.
• Further research is warranted to fully understand aspiration risk in this population.