118 - External Abdominal Support and Gastrointestinal Outcomes in Preterm Infants on Continuous Positive Airway Pressure: A Case Series

Publication Number: 2113.118

Tiana Nguyen, UCSF, San Francisco, CA, United States; Emily M. Gayton, UCSF Benioff Children's Hospital San Francisco, Oakland, CA, United States; Caroline A. Norell, University of California San Francisco, Oakland, CA, United States; Caitlin R. Royse, UCSF Benioff Children's Hospital San Francisco, San Mateo, CA, United States; Marie-Coralie Cornet, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Hannah Gu, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: Infants born < 32 weeks' gestation require continuous positive airway pressure (CPAP) for respiratory support. A frequent side effect, "CPAP belly syndrome," causes gaseous abdominal distension that may limit diaphragmatic excursion, cause discomfort, and contribute to feeding intolerance. External, noninvasive abdominal support has been proposed to stabilize the abdominal wall and mitigate these effects; however, data on safety and clinical outcomes remain limited.

Objective: To describe gastrointestinal (GI) and safety outcomes in preterm infants receiving an external abdominal support while on CPAP.

Design/Methods: This within-subject, pre-post case series included 16 preterm infants (23-30 weeks' gestation) admitted to a level IV NICU who received external abdominal support. Eligibility criteria included age ≥7 days, ongoing CPAP or non-invasive Neurally Adjusted Ventilatory Assist (NAVA), intact trunk skin, and ≥120 mL/kg/day enteral feeds for ≥24 hours. Exclusion criteria included active GI pathology (e.g., necrotizing enterocolitis [NEC], spontaneous intestinal perforation), GI surgery, or inability to stool spontaneously. Infants wore the support continuously while on CPAP (any FiO2/PEEP), with brief removals for routine skin checks. Adherence was calculated as the proportion of eligible days the infant wore the support. Primary GI outcomes were the number of emesis episodes a week, glycerin suppositories used, and abdominal x-rays obtained for distension. Safety outcomes included NEC and skin integrity. Pre- and during-intervention values were compared using Wilcoxon signed-rank tests.

Results: Median (IQR) postmenstrual age (PMA) at initiation was 31(28-37) weeks and at discontinuation 36 (34-48) weeks (Table 1). Median adherence rate was 100% (IQR: 67-100%). Emesis frequency decreased from a median (IQR) of 1.84 (0-8.08) episodes/week before the intervention to 0.87 (0-4.8) during the intervention (p=.05) (Table 2). Median glycerin use and abdominal x-rays remained stable. No infants developed NEC. One infant experienced two episodes of mild skin breakdown from incorrect application, both resolving within 48 hours after temporary discontinuation of the support, which was then safely resumed.

Conclusion(s): External abdominal support was feasible, well tolerated, and associated with fewer emesis episodes among these 16 preterm infants on CPAP. These findings suggest targeted abdominal stabilization may improve feeding tolerance without adverse events. Larger prospective studies are needed to evaluate its impact on respiratory and feeding outcomes.

Infant Characteristics
PMA: post-menstrual age; NAVA: Neurally Adjusted Ventilatory Assist

Comparison of Feeding Tolerance Before and During the Abdominal Support Intervention