A thickened formula reduces feeding-associated oxygen desaturation and bradycardia in preterm infants

Abstract

Background: Although preterm infants often experience desaturation or bradycardia during oral feeding, specific guidelines for its management are lacking.

Purpose: This study aimed to investigate the effects of a commercial thickened formula (TF) on oxygen saturation and heart rate stabilization during oral feeding in preterm infants.

Methods: This retrospective study included 122 infants born at a median (interquartile range [IQR]) 31+6 weeks (29+4 -34+6 weeks) of gestation weighing 1,725 g (1,353-2,620 g) and fed commercial cornstarch-containing TF due to feeding-associated desaturation or bradycardia. We excluded infants fed TF to treat symptomatic regurgitation. Desaturation and bradycardia events were compared between 3 days prior to the change and 3 days after the change to TF. Desaturation and bradycardia were defined as SpO2 <85% and heart rate <100 beats/min during or immediately after oral bottle feeding, respectively.

Results: The median (IQR) postmenstrual age and weight were 36+1 weeks (34+6-38+0 weeks) and 2,395 g (2,160-2,780 g), respectively, at the time of change to TF. The frequency of desaturation significantly decreased after TF feeding (median [IQR]: 2.3 [1.3-3.3] events/day vs. 0.3 [0-1.7] events/day, P< 0.001). Bradycardia also decreased after TF feeding (0.3 [0-1] events/day vs. 0 [0-0.7] events/day, P=0.006). There were no cases of diarrhea or electrolyte abnormalities after TF feeding. Defecation frequency decreased (P=0.037), and polyethylene glycol was prescribed to 27% of the TF-fed infants. In a subgroup analysis of 16 infants with bronchopulmonary dysplasia, the frequency of desaturation was reduced (2.3 [1.8-3.8] events/day vs. 0.5 [0-1.5] events/day, P=0.042), and weight gain improved (22.5 [3.1-36.3] g/day vs. 41.3 [28.1-55.1] g/day, P=0.019), after TF feeding.

Conclusion: TF feeding significantly reduces oral feeding-associated oxygen desaturation and bradycardia in preterm infants. TF may be useful for stabilizing oxygen saturation and heart rate among preterm infants with difficulties in oral feeding.

Keywords: Bottle feeding; Feeding behavior; Infant nutritional physiological phenomena; Thickened.

Fig. 1.

Box plots of frequency of bradycardia and desaturation before versus after the change to a thickened formula. The median (interquartile range [IQR]) frequency of bradycardia decreased from 0.3 (0–1) events/day to 0 (0–0.7) events/day (P =0.006). The frequency of desaturation also significantly decreased from 2.3 (1.3–3.3) events/day to 0.3 (0–1.7) events/day (P <0.001). The box represents IQR and the line across the box indicates the median. The vertically extending lines denote the minimum and maximum values within 1.5× IQR, while the outlier dots denote observations outside the range of the adjacent value (1.5× IQR). Bradycardia and desaturation were defined as heart rate <100 beats/min and SpO₂ <85% during or immediately after oral bottle feeding, respectively.

Fig. 2.

Representative vital sign trend showing improved bradycardia and desaturation after change to a thickened formula.