None listed
Conditions
Brief summary
Infants born prematurely often require gastric tube feeding. The transition from gastric tube feeds to sucking feeds (breast and/ or bottle) usually starts around 32-34 weeks’ post menstrual age when infants begin to demonstrate the ability to coordinate sucking, swallowing and breathing. However, during sucking feeds immature infants may experience physiological instability, including lower oxygen saturations (SpO2) and heart rates (HR), and periods of apnoea or cyanosis. However, preterm infants may have sucking feeds by bottle for a number of reasons, for example infants whose mothers are no longer expressing, or who are unable to be present for a breastfeed. During bottle feeds infants typically feed cradled in a flexed, semi-reclining “en face” position. In contrast, during breastfeeding infants’ are generaly placed so that they lie across the mother’s abdomen in an unflexed position with the infant’s head in a straight line with their body. In a pilot study, comparing a side-lying position against a semi-upright position for bottle feeding preterm infants, Clark reported an improvement in SpO2 measurements in the side-lying position In our previous study at RWH with 25 preterm infants we showed there was little difference in mean (SD) SpO2 during feeds between the cradle-hold and side-lying position 94(6)% versus 95(6)% respectively (p=0.55, CI -1.4, 5.4). During feeds 17/ 25 (68%) experienced a period of SpO2 <80% in the cradle-hold position compared with 14/25(56)% in the side-lying position (p=0.26, CI 0.68, 4.10). However, in post hoc analysis we saw that in 8 infants receiving respiratory support during feeds 7/8 (87%) versus 5/8 (62%) in cradle versus side lying feeding positions experienced a SpO2 < 80% (p=0.25). There are several reports showing that there is a reduction in oxygen saturation in preterm infants with bronchopulmonary dysplasia (BPD) during bottle feeds in the cradle-hold position. Residual lung disease is probably the most prevalent sequela of prematurity that affects feeding. There are no reports measuring the effect of alternate bottle feeding positions for infants receiving respiratory support during bottle feeding. We hypothesise that for infants who are receiving respiratory support there might be increased physiological stability during bottle-feeding in the side-lying versus the cradle-hold position. The aim of this study is to determine the physiological stability and efficiency of bottle feeding in the side lying position (SLP) in preterm infants receiving respiratory support who are transitioning to suck feeds.
Interventions
Infants will have a study feed in two positions, the standard cradle-hold and the side-lying position. Infants will have a maximum of 30 minutes to complete the feed. If the total volume of milk offered is not consumed it will be admiinistered via the infants gastric tube.
At least 12hours later they will have the second feed in the alternate position.
Sponsors
The Royal Women's Hospital
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
23 Weeks to 33 Weeks
Healthy volunteers
No
Inclusion criteria
Infants born preterm (<34weeks gestation) who are having bottle feeds whilst currently recieiving respiratory support, eg CPAP, or sub nasal oxygen administered at low or high flows
Exclusion criteria
Infants with craniofacial/structural abnormalities. Infants receiving bottle feeds using a special needs bottle. Infants who are likely to be transferred to another neonatal unit before both study feeds can be completed.
Outcome results
None listed