Oral Feeding for Infants and Children Receiving Nasal Continuous Positive Airway Pressure and High-Flow Nasal Cannula Respiratory Supports: A Survey of Practice

Abstract

To investigate oral-feeding practices for infants and children receiving nasal continuous positive airway pressure (nCPAP) and high-flow nasal cannula (HFNC) respiratory support. A survey was sent to Neonatal (NICU) and Paediatric Intensive Care Units (PICU) in Australia and New Zealand to explore feeding practices for infants/children receiving nCPAP and HFNC, including criteria for commencing/recommencing oral feeding, frequency of oral feeding, strategies to assist oral feeding, assessment tools, reasons for not orally feeding, existence of written guidelines and staff opinion regarding feeding safety. Seventy-seven individual survey responses were analysed from 49 units from 38 hospitals. Most units (53%) reported that infants/children are 'never or rarely' fed orally on nCPAP compared with 21% on HFNC. 2% of units 'often' feed infants on nCPAP whilst 38% 'often' feed on HFNC. Oral feeding on HFNC is more likely to occur in a NICU (100% sometimes/often) than a PICU (55% sometimes/often) setting. Only 4% of infants are often fed orally on nCPAP versus 54% on HFNC in NICUs. Eighty percent of all units reported they do not have a written policy or guideline that includes feeding recommendations for infants/children receiving non-invasive respiratory supports. Oral feeding for infants and children receiving nCPAP and HFNC is occurring in NICU and PICUs in Australia and NZ. There is varied opinion regarding the safety of oral feeding on nCPAP and HFNC. Further research is recommended, including studies with instrumental assessment of swallow safety and investigation of short and long-term feeding outcomes, to guide clinicians in this area of practice.

Keywords: Children; HFNC; Infants; Oral feeding; Swallowing; nCPAP.