Oral feeding on nasal CPAP??

[Carmen Huston]

Our NICU neonatologists and nurses disagree amongst each other if oral feeding on nasal CPAP is safe. Pulmonary and ENT agree with feeding/dysphagia therapies that these kids are too respiratory compromised and that there is a high risk of aspiration with decreased airway closure. There is also disagreement on other general respiratory readiness paramaters. For example, feeding on >2L of O2 and feeding on high flow nasal cannula.

Please respond:

1. Do you have specific respiratory parameters/criteria for oral feeding? Such as

2. Do you ever orally feed on nasal CPAP and if you do, when or what specific parameters do you have? Such as FiO2

[NicuGal, MSN, RN]

We do feed kids on CPAP and high flow cannulas and vapotherm, but they are fed with an OG usually. We typically don't nipple these kids. High flow cannulas we feed up to 3 liters regardless of FIO2 as long as they are stable and are ready to eat. We don't nipple with resps over 60, some kids 70 if 60's have been their baseline for ages, we hold feeds at 80 or greater. When we gavage feed the CPAP and vapotherms we always vent the tubing about an half an hour to an hour after. We assess tolerance of feeds by way of VS and aspirates.

I'm kind of not getting where you are coming from with the silent aspiration...I can't say I've run into that but on a handful of kids and they are usually neuro. If they have reflux we do an UGI test on them or if they are neuro the same, but we don't take all our kids down for UGI or swallows.

[laynaER]

On my unit they are fed via OG tube. I dont see how nipple feeding these kids can be safe if they are requiring pressure to keep their airway open. Good suck, swallow, breathe coordination can't possibly be achieved that way. If a baby is tachypneic to 70s we wont nipple feed either.

[NeoPediRN]

No to pretty much all of the above. We don't PO feed babies on nasal CPAP period. We do allow PO feeds for babies on high flow but no more than 20 minutes a time and stop earlier for respiratory distress above and beyond their baseline. I've seen babies PO fed on as high as 5L 40%. We address PO feeds on regular NC babies on a case-by-case basis. Most of are babies have severe respiratory compromise to begin with. I remember feeding a trached baby on PC/PS vent settings whose baseline RR was in the 70s. We would let that baby PO feed until RR reached 100 or had significant retractions. It is policy for all trached babies to have an MBS before PO feeding, and any baby with a hx of aspiration pneumonia.

[Carmen Huston]

Thank you for your responses. If you feel comfortable, can you please let me know what centers you work at. I am happy to hear that you have similar parameters for oral feeding and I am trying to compile information to present to our neonatologists to determine best practice. I am a feeding therapist currently working at Dell Children's Hospital and previosly worked in the SF Bay area at UCSF and CPMC. Thank you!

[Isabelle49]

I haven't been in NICU is years, but I don't think I would want to nipple feed a baby on CPAP. It would seem that the positive pressure could force feeding into the airway! Could these babies tolerate a nasal cannula for feeding time? That would be better, if not safer.

I worked at Ochsner Hospital NICU in New Orleans. It is a Level III NICU.

[umcRN, BSN, RN]

Definitely not on CPAP, feeding for those babies by OG only. Oral feeding doesnt start until on at least 4L Vapotherm.

I have also fed a trached/vented baby whose work of breathing actually went down during feeding because she would let the vent take over and only focus on eating, however most nurses were not comfortable with this and this was done only at the parents insistence that she be po feeding. She did get a MBS prior to being allowed

[GrowingBabies]

No nipple feeds for cpap kids in our unit, the risk is too great.

Sometimes we nipple H3F babies depending on the case. Very frequently feed babies on a regular cannula. As always, we have to watch kids closely before PO feeds and often do not offer nipple feeds if RR >65 (unless babe has a high baseline for ages and show no s/s of distress).