Neonatal Med.  2023 May;30(2):49-54. 10.5385/nm.2023.30.2.49.

The Impact of Slow Infusion Intermittent Feeding on Gavage Feeding-Associated Cardiorespiratory Deterioration in Neonatal Intensive Care Unit Infants

• Kim MJ
• Kim HS
• Jung YH
• Choi CW

• KMID: 2542547
• DOI: http://doi.org/10.5385/nm.2023.30.2.49

Abstract

Purpose
Infants in the neonatal intensive care unit (NICU) often show cardiorespiratory deterioration during gavage feeding. We aimed to determine whether slow infusion intermittent feeding (SIIF) can reduce respiratory deterioration during gavage feeding in preterm infants in the NICU.
Methods
Data on preterm infants whose gavage feeding method was changed to SIIF (1-­­hour infusion with an infusion pump and 2-­hour rest within a 3­-hour interval) from bolus gravity feeding (2-­ or 3-­hour interval) due to feeding­-associated cardiorespiratory deterioration were retrospectively reviewed. A significant cardiorespiratory event was defined as a saturation level below 80% or heart rate below 80 bpm. We compared the frequency of cardiorespiratory events and the level of respiratory support 24 hours before and after the application of SIIF.
Results
A total of 34 infants were enrolled and analyzed. The total frequency of desaturation or bradycardia significantly decreased after SIIF application (8.94 vs. 5.03, P=0.001). The frequency of feeding-­related bradycardia and desaturation also significantly decreased (4.15 vs. 1.68, P=0.008). Out of 34 patients, 11 (32.4%) had a decreased level of ventilator support within 1 day after SIIF. The respiratory severity scores of the 10 patients who received invasive ventilator support decreased significantly after SIIF (5.24 vs. 4.59, P=0.032).
Conclusion
SIIF significantly decreased gavage feeding­-associated cardiorespiratory events and reduced respiratory support in approximately one-­third of subjects. Therefore, SIIF may be a therapeutic option for gavage feed-­associated respiratory deterioration in preterm infants in the NICU.

Keyword

Enteral nutrition; Slow infusion intermittent feeding; Preterm infant

Figure

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  Figure 1. Comparison of the cardiorespiratory event frequency before and after slow infusion intermittent feeding (SIIF). (A) Comparison of total cardiorespiratory event frequency before and after SIIF. Total frequency of bradycardia or desaturation was significantly decreased after the application of SIIF (8.94±8.29 vs. 5.03±6.24, P=0.001). (B) Comparison of feeding-related cardiorespiratory event frequencies before and after intermittent slow infusion feeding. The frequency of feeding-related cardiorespiratory events was significantly decreased after the application of SIIF (4.15±5.52 vs. 1.68±2.27, P=0.008). The white and grey boxes represent pre-SIIF and post-SIIF, respectively. ‘x’ indicates the mean value, the horizontal line in the middle of the box is the median value of the frequencies, and the lower and upper boundaries indicate the 25th and 75th percentiles, respectively. *P-values less than 0.05.

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  Figure 2. Comparison of respiratory severity scores (RSSs) before and after slow infusion intermittent feeding (SIIF) in patients with invasive ventilator support. The RSS of the 10 patients receiving invasive ventilator support significantly decreased after SIIF (5.24 vs 4.59, P=0.032). The white and grey boxes represent pre-SIIF and post-SIIF, respectively. ‘x’ indicates the mean value, the horizontal line in the middle of the box is the median value of the frequencies and the lower and upper boundaries indicate the 25th and 75th percentiles, respectively. *P-value less than 0.05.

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