The evidence-base for safe and successful feeding for preterm and at risk infants in the NICU and after discharge continues to emerge. This latest addition from our European colleagues reinforces our clinical impressions that during PO feeding, elevated sidelying and co-regulated pacing are beneficial for both breathing and swallowing.
Hübl, N., Hasmann, J., Riebold, B., Kaufmann, N., & Seidl, R. O. (2024). Effect of feeding in elevated side-lying and paced bottle feeding on swallow-breathe coordination in healthy preterm infants–First results. Early Human Development, 106184.
Abstract
Background
Preterm infants face challenges in their suck-swallow-breathe coordination leading to an increased risk of aspiration. Key components of the swallowing process are present around 34 to 35 weeks postmenstrual age (PMA), but preterm infants fatigue early affecting timing, quality and efficiency in swallowing and prolonging breathing pauses. Feeding strategies need to address these specific challenges in suck-swallow-breathe coordination.
Aim
To objectively measure the effect of positioning and applying “paced bottle feeding” on swallowing and breathing function in preterm infants.
Methods
Two separate groups of each 20 preterm infants were measured during a single bottle feed at the age of 34 to 35 weeks PMA using a noninvasive measuring device combining bioimpedance, surface electromyography as well as a breathing belt. In the first study (S1) feeding in elevated side-lying was compared to elevated supine position for 2 min each. In the second study (S2) 2 min of paced bottle feeding was compared to 2 min without paced bottle feeding.
Results
(S1): Feeding in elevated side-lying led to significantly fewer episodes of choking and coughing, significantly shorter breathing pauses and significantly less variation in swallowing movements than in elevated supine. Pharyngeal closure was significantly greater in supine at the start of the feed. (S2): The application of paced bottle feeding significantly reduced the length of breathing pauses.
Conclusions
Feeding in elevated side-lying position and applying paced bottle feeding may support improved swallow-breathe coordination in healthy preterm infants at 34 to 35 weeks PMA.