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Oral Feeding in Infants After Congenital Diaphragmatic Hernia Repair While on Non-invasive Positive Pressure Ventilation: The Impact of a Dysphagia Provider-Led Protocol

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Abstract

Infants with congenital diaphragmatic hernia (CDH) who require non-invasive positive pressure ventilation or high flow nasal cannula are at risk for aspiration and delayed initiation of oral feeding. We developed a dysphagia provider-led protocol that involved early consultation with an occupational therapist or speech/language pathologist and modified barium swallow study (MBSS) to assess for readiness for oral feeding initiation/advancement on non-invasive positive pressure ventilation. The objective of this study was to retrospectively compare this intervention cohort to a historical control cohort to evaluate the protocol’s impact on the time to initiate oral feeding. We describe the development and implementation of the protocol, the MBSS findings of the intervention cohort, and compared the control (n = 64) and intervention (n = 37) cohorts using Fischer’s exact test and Mann–Whitney test. We found that both cohorts had similar prenatal and neonatal characteristics including age at extubation. Significantly more infants in the intervention cohort were on non-invasive positive pressure ventilation or high flow nasal cannula at the time of oral feeding initiation (84% vs. 28%, p < 0.0001). None of the control cohort infants underwent MBSS while on respiratory support. Of the intervention cohort, 15 infants underwent a MBSS while on non-invasive positive pressure ventilation; 6 had no evidence of laryngeal penetration and/or aspiration during swallowing. Infants in the control cohort initiated oral feeds significantly sooner after extubation (6 versus 11 days, p = 0.001) and attained full oral feeds earlier (20 days versus 28 days, p = 0.02) than the intervention group. There was no difference in the rate of gastrostomy tube placement (38%). Appropriate monitoring by a dysphagia provider and evaluation with clinical and radiological means are crucial to determine the safety of initiating oral feeding in term infants with CDH. Continued surveillance is needed to determine the long-term impact on oral feeding progression in this population.

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References

  1. Migliazza L, Bellan C, Alberti D, Auriemma A, Burgio G, Locatelli G, et al. Retrospective study of 111 cases of congenital diaphragmatic hernia treated with early high-frequency oscillatory ventilation and presurgical stabilization. J Pediatr Surg. 2007;42(9):1526–32.

    Article  Google Scholar 

  2. Rudra S, Adibe OO, Malcolm WF, Smith PB, Cotten CM, Greenberg RG. Gastrostomy tube placement in infants with congenital diaphragmatic hernia: frequency, predictors, and growth outcomes. Early Hum Dev. 2016;103:97–100.

    Article  Google Scholar 

  3. Vu LT, McFarland C, Bratton B, Lee H. Closer look at the nutritional outcomes of patients after primary repair of congenital diaphragmatic hernia. J Pediatr Gastroenterol Nutr. 2017;65(2):237–41.

    Article  Google Scholar 

  4. Goday PS, Huh SY, Silverman A, Lukens CT, Dodrill P, Cohen SS, et al. Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework. J Pediatr Gastroenterol Nutr. 2019;68(1):124–9.

    Article  Google Scholar 

  5. Kurtz JD, Chowdhury SM, Woodard FK, Strelow JR, Zyblewski SC. Factors associated with delayed transition to oral feeding in infants with single ventricle physiology. J Pediatr. 2019;211:134–8.

    Article  Google Scholar 

  6. Ferrara L, Bidiwala A, Sher I, Pirzada M, Barlev D, Islam S, et al. Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates. J Perinatol. 2017;37(4):398–403.

    Article  CAS  Google Scholar 

  7. Canning A, Fairhurst R, Chauhan M, Weir KA. Oral feeding for infants and children receiving nasal continuous positive airway pressure and high-flow nasal cannula respiratory supports: a survey of practice. Dysphagia. 2020;35(3):443–54.

    Article  Google Scholar 

  8. Cichero JAY, Lam PTL, Chen J, Dantas RO, Duivestein J, Hanson B, et al. Release of updated International Dysphagia Diet Standardisation Initiative Framework (IDDSI 2.0). J Texture Stud. 2020;51(1):195–6.

    PubMed  Google Scholar 

  9. Raczynska A, Gulczynska E. The impact of positioning on bottle-feeding in preterm infants (</= 34 GA). A comparative study of the semi-elevated and the side-lying position—a pilot study. Dev Period Med. 2019;23(2):117–24.

    PubMed  PubMed Central  Google Scholar 

  10. Park J, Pados BF, Thoyre SM. Systematic review: what is the evidence for the side-lying position for feeding preterm infants? Adv Neonatal Care. 2018;18(4):285–94.

    Article  Google Scholar 

  11. Jadcherla SR, Bhandari V. “Pressure” to feed the preterm newborn: associated with “positive” outcomes? Pediatr Res. 2017;82(6):899–900.

    Article  CAS  Google Scholar 

  12. Dumpa V, Kamity R, Ferrara L, Akerman M, Hanna N. The effects of oral feeding while on nasal continuous positive airway pressure (NCPAP) in preterm infants. J Perinatol. 2020;40(6):909–15.

    Article  Google Scholar 

  13. Leibel SL, Castro M, McBride T, Hassall K, Sarmiento K, Ye XY, et al. Comparison of Continuous positive airway pressure versus High flow nasal cannula for Oral feeding Preterm infants (CHOmP): randomized pilot study. J Matern Fetal Neonatal Med. 2020. https://doi.org/10.1080/14767058.2020.1735339.

    Article  PubMed  Google Scholar 

  14. Hanin M, Nuthakki S, Malkar MB, Jadcherla SR. Safety and efficacy of oral feeding in infants with BPD on nasal CPAP. Dysphagia. 2015;30(2):121–7.

    Article  Google Scholar 

  15. Wong MKW, Haliburton B, Graham A, Lapidus-Krol E, Moraes TJ, Marcon MA, et al. Requirement and duration of tube feed supplementation among congenital diaphragmatic hernia patients. J Pediatr Surg. 2019;54(5):895–8.

    Article  Google Scholar 

  16. Manani M, Jegatheesan P, DeSandre G, Song D, Showalter L, Govindaswami B. Elimination of admission hypothermia in preterm very low-birth-weight infants by standardization of delivery room management. Perm J. 2013;17(3):8–13.

    Article  Google Scholar 

  17. Haddock C, Al Maawali AG, Ting J, Bedford J, Afshar K, Skarsgard ED. Impact of multidisciplinary standardization of care for gastroschisis: treatment, outcomes, and cost. J Pediatr Surg. 2018;53(5):892–7.

    Article  Google Scholar 

  18. Bence CM, Rymeski B, Gadepalli S, Sato TT, Minneci PC, Downard C, et al. Clinical outcomes following implementation of a management bundle for esophageal atresia with distal tracheoesophageal fistula. J Pediatr Surg. 2021;56(1):47–54.

    Article  Google Scholar 

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Funding

This project was supported by the National Institutes of Health Grant Number T32AI125222. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Division of Pediatric Surgery, University of California San Francisco, San Francisco, CA, USA

    Marisa E. Schwab, Mary Kate Klarich & Lan T. Vu

  2. Department of Occupational Therapy, University of California San Francisco, San Francisco, CA, USA

    Miriam Crennan & Helen Sang

  3. Department of Nutrition and Food Services, University of California San Francisco, San Francisco, CA, USA

    Shannon Burke

  4. Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA

    Roberta L. Keller

Authors
  1. Marisa E. Schwab
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  2. Miriam Crennan
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  4. Helen Sang
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  5. Mary Kate Klarich
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  6. Roberta L. Keller
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  7. Lan T. Vu
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Correspondence to Marisa E. Schwab.

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Schwab, M.E., Crennan, M., Burke, S. et al. Oral Feeding in Infants After Congenital Diaphragmatic Hernia Repair While on Non-invasive Positive Pressure Ventilation: The Impact of a Dysphagia Provider-Led Protocol. Dysphagia 37, 1305–1313 (2022). https://doi.org/10.1007/s00455-021-10391-4

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  • DOI: https://doi.org/10.1007/s00455-021-10391-4

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