2 | METHODS
We prospectively studied gastric emptying in very low birth weight
(VLBW) infants treated with either MD-nCPAP or bCPAP from May 2018 to
March 2020. The study was approved by Northwell Health Institutional
Review Board (Manhasset, NY). Informed consent was obtained from parents
before enrollment. Inclusion criteria included infants 25-34 weeks of
gestational age (GA) at birth receiving full enteral feedings and
treated with either MD-nCPAP or bCPAP for RDS. Infants with major
congenital anomalies, gastrointestinal disease or surgery, and those
treated with systemic antibiotics or GIT motility medications were
excluded from the study.
Per NICU protocol, infants who are not mature enough to nipple feed are
fed by bolus every 3 hours via orogastric tube (OGT). After minimal
enteral trophic feedings are tolerated for 1-2 days, the feedings are
increased daily by ~20 mL/kg/day until full enteral
feeding volumes of 160 ml/kg/day are achieved. Feedings are fortified to
24 kcal/oz using Similac Human Milk Liquid Fortifier (Abbott Nutrition,
Abbott Park, IL, USA) when enteral feeding volumes reach
~60 ml/kg/day. Parenteral nutrition (PN) support is
discontinued when infants tolerate ~120 mL/kg/day of
enteral feeding. Gavage feedings were provided over a feeding pump for
60 minutes period. The stomach is decompressed by opening the OGT to
straight drainage 30 minutes after completion of feeding. All infants
are examined every 3 hours for vomiting, abdominal distention, bowel
sounds, bowel movement and abdominal wall softness. Gastric residuals or
aspirates are checked only when an OGT is placed or replaced, or if
there is a clinical indication. Feeding intolerance was defined as the
withholding of feedings by the attending physician because of one or
more of the following: bilious emesis, significant abdominal distention,
abnormal bowel auscultation or abnormal vital signs.
Treatment of apnea of prematurity and RDS includes administration of IV
or PO caffeine together with either MD-nCPAP or bCPAP. During the study
period, our NICU was transitioning from using MD-nCPAP to bCPAP, with
the choice dependent solely on the availability of bCPAP at the time of
patient’s admission. MD-nCPAP was delivered by AVEATM(Vyaire Medical, Inc., Chicago, IL, USA) mechanical ventilator and
administered through RAM cannula® (Neotech, Valencia,
CA, USA). Bubble CPAP was delivered by a commercially available system
(Fisher & Paykel Healthcare Ltd., Auckland, New Zealand) connected to
Babi.Plus® nasal prongs (Respiralogics, NV, USA).
Oxygen saturations were maintained between 88% and 95% as per NICU
protocol. Upper airways and mouth were gently suctioned on an as-needed
basis to keep them clear. Infants’ necks were kept in slight extension.