473 - Impact of Respiratory Tract Infections on Feeding Milestones and Aerodigestive Outcomes in Premature Infants

Publication Number: 2461.473

Elizabeth Ramos Orosco, Nationwide Children's Hospital, Columbus, OH, United States; Jenny Bellodas Sanchez, Nationwide Children's Hospital, Columbus, OH, United States; Faith Bala, Nationwide Children's Hospital, Columbus, OH, United States; Enas Alshaikh, Nationwide Children's Hospital, columbus, OH, United States; Sudarshan R. Jadcherla, Nationwide Children's Hospital, Columbus, OH, United States

Background: Infants in the neonatal intensive care unit (NICU) suffer from pulmonary pathologies due to structural and functional aerodigestive immaturity, weak immunity, multiple interventions and exposures. Healthy premature infants acquire feeding milestones by full term age (PMID:31658999). The role of respiratory tract infections (RTIs), both bacterial (B-RTI) and viral (V-RTI), on feeding milestones, length of hospital stays (LOHS) and aerodigestive outcomes at discharge remains unclear.

Objective: To characterize the effects of neonatal RTIs on feeding milestones, LOHS and aerodigestive outcomes and to compare the impact of B-RTI vs V-RTI.

Design/Methods: Retrospective analysis of 29 NICU infants (26.9± 3.2 weeks gestational age, GA) with RTIs was undertaken. These infants were referred to our feeding program for evaluation of missed feeding milestones. Multidisciplinary personalized feeding and aerodigestive interventions were provided. Clinical and outcome characteristics in all RTI infants are described, and data comparisons were made between B-RTI vs V-RTI groups.

Results: Table 1. Summarizes demographics, feeding milestones, aerodigestive and discharge outcomes in RTI infants. At discharge, 69% required respiratory support, while the rest 31% were on room air. Only 28% infants achieved full oral feeds, whereas 72% required a gastrostomy or nasogastric tube support. The GA of infants with B-RTI vs V-RTI was 26.4 ± 3.1 weeks vs. 29.5 ± 2.9 weeks, p = 0.03. The postmenstrual age (PMA) at RTI in B-RTI vs V-RTI groups, were 32.2 ± 6.4 weeks vs. 43.8 ± 7.8 weeks, p=0.01. Nutritional methods in B-RTI were notable for 59% on IV fluids one-week prior to RTI, 66% during RTI and 55% one-week post RTI, contrasting with viral RTI infants who were on enteral feeds at all these 3 time points (all, p < 0.01). Growth outcomes are summarized in Table 2. Weight z-score change from birth to discharge was significantly different between groups (−0.2 ± 1.1 for B-RTI vs. +1.0 ± 0.7 for V-RTI, p = 0.02), suggesting better growth recovery in V-RTI infants.

Conclusion(s): Significantly, in premature infants with RTIs, delays with feeding milestones, prolonged LOHS, gastrostomy rates and respiratory support needs are greater at discharge. Feeding progression and growth outcomes differ between bacterial and viral infections, with V-RTI infants showing better growth recovery. Age-matched concurrent controls are needed to assess environmental and practice effects, as well as potential pathophysiological mechanisms.

Table 1. Demographics, Feeding Milestones, and Discharge Outcomes in NICU Infants with RTIs
CPAP: continuous positive airway pressure; DC: discharge; DOL: day of life; GA: gestational age; IVF: intravenous fluids; LOHS: length of hospital stay; PMA: postmenstrual age; PO: per oral; RTI: respiratory tract infection. Values stated as means ± SD or N (%). All P-values were two-sided and were considered significant at p < 0.05.

Table 2. Growth progression from birth to discharge in NICU Infants with RTIs
DC: discharge. All P-values were two-sided and were considered significant at p < 0.05.