328 - Earlier speech therapy is associated with decreased length of NICU stay in preterm infants <28 weeks of birth gestational age.

Publication Number: 4322.328

Amanda Mosher, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Kaylee N. Freid, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Jessica P. Walker, Atrium Health Wake Forest Baptist Health, Advance, NC, United States; Peter J. Porcelli, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Jennifer Check, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Parvesh Garg, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States

Background: Extremely low gestational age newborns (ELGAN, ≤28 weeks) are at risk for systemic morbidities that impact length of hospital stay and long-term clinical outcomes. Nutritional support is critical for the growth and development of preterm infants.

Objective: We compared early ( < 40 week) vs. late (≥40 week) consultation for speech therapy (ST) for feeding difficulties in ELGAN and their long-term outcomes to describe the clinical impact of ST at different post-conceptual ages (PCA).

Design/Methods: Infants with a birth GA of 24-28 weeks who received ST from 2022-2024 were enrolled retrospectively. A regression comparing birth GA to post conceptual age at adlib feed transition determined two cohorts. R-software was used to compare clinical outcomes between the cohorts and p-value < 0.05 was considered significant.

Results: 84 infants received ST < 40 weeks PCA (group A) compared to 31 infants ≥40 weeks PCA (group B). At time of first visit, group A infants were more often tube fed than group B (94.0% vs 77.4%, p< 0.01). Comorbidities such as bronchopulmonary dysplasia and intraventricular hemorrhage were associated with later age at first ST visit (42.9% group A vs. 58.1% group B, p< 0.01). Though not significant, there was a trend toward infants at lower GA at birth reaching adlib status later than infants born at higher GA (Figure). Group B had significantly higher mean number of occupational therapy (OT) and ST visits during their hospital stay (13.2 vs 20.7 OT; 11.6 vs 18.2 ST, p< 0.01). Group A had higher rates of milk penetration (76.7% vs. 50% p< 0.01) and 2:1 consistency laryngeal penetration (10% vs. 0% p< 0.01). Group B had higher rates of laryngeal penetration at 1:1 consistency (58.3% vs. 20% p< 0.01) and aspiration at 1:2 consistency (90% vs. 64.3% p< 0.01). Group B had a longer mean length of hospital stay (85.8 ± 42.4 days vs 106.0 ± 70.5 days, p=0.05). While no significant difference in tube-feeding at discharge, at 6- and 12-month follow up, group B was tube fed more often than those in group A (10.3% vs 41.4%, p< 0.01 at 6 months, 21% vs 66.7%, p< 0.01 at 12-months). There was no significant difference in Ages and Stages Questionnaire scores at 6 months.

Conclusion(s): Group B was at higher risk of aspiration and laryngeal penetration with higher consistencies (1:1 and 2:1), had higher rates of comorbidities during their NICU stay and required longer LOS. Infants in group B required more therapy, which may be due to the delay in initiation of ST. While group A required more tube feeding initially, they achieved earlier oral feeding at 6- and 12-month long-term follow up compared to group B.

Clinical features and feeding outcomes.


Age at Adlib Feed Transition.