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ARTICLE: Chanda Simpson, Richard J. Schanler, and Chantal Lau Early Introduction of Oral Feeding in Preterm Infants Pediatrics 2002; 110: 517-522 [Abstract] [Full text] [PDF]

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Early Oral Feeds in Preterm Infants

Victor C. Herson   (1 October 2002)

Early Oral Feeds in Preterm Infants

Chantal Lau, Chanda Simpson, Richard J Schanler   (11 October 2002)

Early Oral Feeds in Preterm Infants 1 October 2002
Victor C. Herson, Neonatologist Connecticut Children's Medical Center Send letter to journal: Re: Early Oral Feeds in Preterm Infants vherson{at}ccmckids.org Victor C. Herson	Two issues which may affect clinicians' decisions on the timing of introduction of oral feeds in preterm infants deserve discussion and were not commented on by the authors. The first is the advisability of oral feeds in infants still on positive airway pressure. According to Table 1, the infants in the experimental group (early oral feeding) were on mechanical ventilation for an average of 6.1 days and nasal CPAP for 24.6 days for a total of 30.7 days of "respriatory support." According to Table 2, the average postnatal age of initiation of oral feeds in this same group was 22.9 days. This would mean that several infants were orally fed before weaning from nasal CPAP. This is not common practice and it would be of interest to know how this subgroup's tolerance and success with oral feeds compared to those not still on CPAP. A second issue is the potential adverse effect bottle feeds may have on successful nursing. Since most of these infants were also being breastfed, was there any difference in breastfeeding success- (e.g.milk transfer, successful or exclusive breastfeeding at discharge) in the early feeding group compared to the control group?
Early Oral Feeds in Preterm Infants 11 October 2002
Chantal Lau, Assisstant Professor Baylor College of Medicine, Chanda Simpson, Richard J Schanler Send letter to journal: Re: Early Oral Feeds in Preterm Infants clau{at}bcm.tmc.edu Chantal Lau, et al.	1. It is correct that some of the infants continued to receive Nasal CPAP therapy when introduced to oral feeding at 31 weeks postmenstrual age. We mentioned in the Methods section that from 0 to 4 oral feeding/day, the same investigator (CS) fed all the infants. This ensured that the infants were handled in a consistent manner and followed our feeding protocol (Fig. 1). We reported that episodes of oxygen desaturation and bradycardia were similar between groups during feeding; this included infants receiving NCPAP therapy. Importantly, our study was not conducted to determine the efficacy/safety of oral feeding and CPAP. However, we acknowledge that infants are precluded in their advancement to oral feeding because of CPAP therapy. We hope that this preliminary study will stimulate others to study a protocol of oral feeding and CPAP therapy. 2. The aim of the study was not to monitor breastfeeding success. However, because our hospital is a strong proponent of breastfeeding, bottle feeding only was offered when mothers could not be present. In addition, there is no evidence to support that early introduction of bottles in this population interferes with breastfeeding. 3. We would like to stress that this study was conducted to determine whether oral feeding skills at 31 wks postmenstrual age allowed successful and safe oral feeding. We are not advocating that oral feeding be started at that time. Rather, we are emphasizing that the delay in the initiation of oral feeding affects success. We hope these responses answer your questions and prompt you to pursue a study on the initiation of oral feeding during NCPAP therapy!