42 - Oral Feeding at Discharge Among Infants with Grade 2-3 Bronchopulmonary Dysplasia

Publication Number: 2039.42

Laura Sillers, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Molly Susi, Nationwide Children's Hospital, Columbus, OH, United States; Melissa Hanin, Nationwide Children's Hospital, Columbus, OH, United States; Julia Welc, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Sandra Wai, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Genevieve Kinsey, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Pamela Griffiths, Phoenix Children's Hospital, Gilbert, AZ, United States

Background: Bronchopulmonary dysplasia (BPD) is associated with dysfunctional oral feeding. While infants with more severe BPD are at highest risk of feeding difficulties, the impact of prolonged respiratory support beyond 36 weeks postmenstrual age (PMA) on oral feeding is undefined. Introducing oral feeds on higher levels of non-invasive respiratory support may improve feeding skill acquisition but has not been evaluated beyond single center studies.

Objective: The primary objective was to describe oral feeding at discharge among BPD infants who require prolonged respiratory support in a large, multicenter cohort. The secondary objective was to describe characteristics of BPD infants by discharge feeding status, including whether infants were exposed to oral feeding on advanced non-invasive support.

Design/Methods: Retrospective cohort study of infants born ≤28 weeks gestational age with grade 2-3 BPD in the BPD Collaborative Registry from January 2010 to September 2025. Infants discharged in room air or on non-invasive respiratory support were eligible for inclusion. Infants who had insufficient data for respiratory support at 36 weeks PMA to determine BPD grade by NRN criteria or to determine discharge oral feeding were excluded. Categorical data were compared with chi-square or Fisher's exact test; continuous data were compared using Kruskal-Wallis test as data were not normally distributed.

Results: 1,519 infants were eligible at eighteen centers (Table 1). Discharge feeding by respiratory support at 36w, 44w, and 50w PMA is shown in Table 2. Invasive ventilation at all time points was associated with lower discharge oral feeding compared to non-invasive respiratory support (all p< 0.001). There were no significant differences in discharge feeding for infants who were on non-invasive positive airway pressure (NI-PAP) vs. nasal cannula (NC) >2 LPM (p=0.74, 0.43, 0.57). Feeding on NI-PAP or NC >2 LPM was not associated with discharge feeding in the overall cohort (p=0.71) but was associated with increased oral feeding at discharge among infants with grade 3 BPD (any oral feeds: 93.1% vs 73.3%, full oral feeds: 51.7% vs 31.7%, p=0.02; Table 3).

Conclusion(s): Failure to reach full oral feeds prior to hospital discharge is common among infants with grades 2-3 BPD, particularly after more prolonged respiratory support. Oral feeding on advanced respiratory support is associated with improved discharge oral feeding in grade 3 BPD, although causality cannot be inferred. Prospective studies evaluating the impact and safety of oral feeding practices are needed given the high burden of feeding challenges in this population.

Table 1: Demographic characteristics by feeding status at discharge
BW: birth weight; GA: gestational age; SGA: small for gestational age

Table 2. Discharge oral feeding status by respiratory support requirement at 36w, 44w, and 50w PMA
NI-PAP: non-invasive positive airway pressure; CPAP: continuous positive airway pressure; BiPAP: bilevel positive airway pressure; LPM: liters per minute; PMA: postmenstrual age. n reflects the number of infants receiving ongoing hospitalization on specified respiratory support at each PMA

Table 3: Clinical characteristics based on discharge feeding status
NI-PAP: non-invasive positive airway pressure, NC: nasal cannula; LPM: liters per minute