Study, year | Respiratory support | SO1: Clinical signs of OPA | SO2: Aspiration pneumonia or antibiotics for suspected aspiration pneumonia | SO3: Decrease in respiratory status/signs of respiratory distress |
---|---|---|---|---|
Bapat 2019 [23] | CPAP (cmH2O not specified) | Not reported | Not reported | Not reported |
Dalgleish 2016 | CPAP (pressure/s not reported), HFNC > 1.5 L/min | No cases of suspected aspiration based on clinical or radiographic observation and no safety concerns noted by nurses, consulting OTs or neonatologists based on individual assessment. | No cases of suspected aspiration based on clinical or radiographic observation. | Oral feedings were stopped at the first sign of stress, which resulted in no infant having worsening respiratory status or physiological instability. |
Dumpa 2020 [24] | Orally fed while on nCPAP 5-8cmH2O vs oral feeding after ceasing nCPAP | Not reported | Not reported | Not reported |
Ferrara 2017 [14] | CPAP 5cmH2O vs LFNC 1 L/min | Not reported | Not reported | Not reported |
Glackin 2017 [25] | nCPAP (pressure/s not reported) vs HFNC commencing at 7 L/min | Adverse events, eg. desaturation and bradycardia, were recorded on proforma data sheets for every feed offered. No details were provided in results- authors stated no adverse outcomes or events in any of the infants. | No cases of aspiration following oral feeds on nCPAP or HFNC | No acute respiratory deterioration occurred in any of the infants in either group. |
Hanin 2015 [26] | nCPAP-oral (6-8cmH2O) vs nCPAP-gavage | Frequency of physiologic and behavioral distress for all feeding sessions (n = 218) that resulted in termination of the bottle feeding: Apnoea or bradycardia events (2.7%, n = 6); Desaturation to less than target FiO2 saturation (11%, n = 25); > 1 episode of coughing or gagging (0.4%, n = 1). | No clinically significant aspiration pneumonia No infants received any antibiotics during the period of nCPAP oral feeding due to suspected aspiration pneumonia. | Oral feedings were terminated when the following occurred: increase in respiratory rate or work of breathing (14%, n = 30). Three events (1%) required supplemental FiO2; one infant had changes in chest x-ray. |
Jadcherla 2016 [27] | nCPAP (6-8 cm H2O) vs NC (0.1–2.0 L/min) vs room air | Not reported | Not reported | Not reported |
La Tuga 2019 | CPAP (cmH2O not reported) vs no CPAP first oral feed | Not reported | No significant difference in aspiration pneumonia between infants who initiated oral feeding on CPAP (n = 76) compared to infants that did not begin oral feeding on CPAP (n = 167), with only one case of aspiration pneumonia reported in each cohort. | Not reported |
Leder 2016 [16] | HFNC 2-3 L/min | 17 NICU patients had ‘successful initiation of oral alimentation’ which was defined as swallowing without overt signs of dysphagia eg. cough or worsening respiratory status. | Not reported | Not reported |
Leibel 2020 [30] | On CPAP minimum of 5cmH2O (orally fed on LFO < 2 L/min) vs on HHHFNC minimum of 5 L/min (orally fed on 2 L/min) | Feeding intolerance defined as “holding or decreasing the volume of feeds by the medical team due to emesis or aspiration (defined as coughing or choking during a feed)” nCPAP 8.33% (1/12), HHHFNC 30.77% (4/13) Aspiration vs emesis not differentiated. | None of the infants developed aspiration while on short-term LFO for the purpose of oral feeding. | None of the infants developed cardio-respiratory decompensation while on short-term LFO for the purpose of oral feeding. |
Leroue 2017 [28] | NIPPV (HFNC, CPAP, BiPAP, AVAPS); CPAP: 6-8cmH2O; HFNC: flow rate/s not reported | Not reported | Development of pneumonia not present at admission (n = 54). Difficult to discern whether a complication of feeding or natural progression of the disease. | 3% (n = 16) of patients receiving NIPPV (n = 562) required intubation after EN initiation, 4 for elective procedures and 12 for progressive respiratory failure. |
Shadman 2019 [29] | HFNC (flow rate/s not reported) | Not reported | One fed infant had antibiotic initiation with radiological documentation of possible pneumonia and physician documentation of suspected aspiration pneumonia. | Not reported |
Shetty 2016 [8] | nCPAP (4-6cmH20) vs nCPAP then transferred to HFNC 2-8 L/min | Not reported | Not reported | Not reported |
Shimizu 2019 [30] | HFNC (2 L/kg/min) vs no HFNC first oral feed | Not reported | No clinically significant aspiration pneumonia in the HFNC group during oral feeding. | No increase in oxygen requirements between the oral feeding on HFNC vs oral feeding without HFNC groups. |
Slain 2016 | HFNC 2-4 L/min vs 5-6 L/min vs > 7 L/min | No documented aspiration or choking events. Data extracted from nursing documentation regarding 70 children who had enteral feeding (89% oral). | Not reported | Feeding-related adverse events (AEs) were categorized as ‘respiratory distress’ (n = 9) or ‘emesis’ (n = 20). AEs documented in 29 of 501 (6%) nursing shifts (434 shifts with oral feeds). |
Sochet 2017 [31] | HFNC 4-13 L/min (0.3–1.9 L/kg/min) | Not reported | Development of aspiration-related respiratory failure occurred in 1 (0.8%) patient | Interruptions in enteral nutrition occurred in 12 (9.1%) children, 10 for tachypnoea, 1 for increased work of breathing |