45 - Identifying early risk factors for post-discharge feeding challenges in extremely preterm infants with bronchopulmonary dysplasia

Publication Number: 2042.45

Jade Roghair, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Paige M.. Nelson, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Allison Momany, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Heidi Harmon, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States

Background: Extremely preterm (EP) infants diagnosed with bronchopulmonary dysplasia (BPD) have increased risk for feeding difficulties and poor growth. Early prediction of post-discharge feeding difficulties may guide timely, individualized interventions to support feeding and growth.

Objective: Identify early neonatal risk factors associated with feeding challenges at 12 months corrected age (CA) among EP infants with BPD.

Design/Methods: We conducted retrospective chart review of EP infants ( < 28 weeks' gestation) with BPD who were discharged on home oxygen and received neonatal care at the University of Iowa Stead Family Children's Hospital between 2018 to 2022. Infants were classified as poor feeders if they met one or more of the following criteria: (1) not consuming all liquids and solids orally at 12 months CA; (2) diagnosis of oral aversion; (3) admission for failure to thrive or initiation of tube feeds. Group comparisons of poor and successful feeders used independent samples t-tests for continuous variables and chi-square tests or Fisher's Exact tests for categorical variables. Variables associated with poor feeding (p < 0.05) were entered into an elastic net logistic regression model (α = 0.5) with 10-fold cross-validation, and those with nonzero coefficients were considered contributing predictors.

Results: Of 168 EP infants with BPD, 47 (28%) were classified as poor feeders. Poor feeders showed high rates of oral aversion at 87% (41/47), and 62% (29/47) remained tube-dependent at 12 months CA. Baseline maternal and infant demographics were comparable between groups. Poor feeders had more severe BPD, evidenced by longer intubation durations (39 vs 59 days), being extubated at older ages (31 vs 33 wk postmenstrual age [PMA]), and being discharged at older ages (42 vs 47 wk PMA). Although they were not more likely to be small for gestational age, weight Z-scores at birth (-0.06 vs -0.48) and at 36 weeks PMA (-0.55 vs -1.07) were lower in poor feeders. Elastic net regression identified low-grade IVH, late-onset sepsis, days of intubation, PMA at weaning from non-invasive ventilation, 36-week PMA weight Z-score, PMA at starting oral feeds, and frequency of caregiver bottle-feeding in the 24 hours before discharge as contributing predictors of poor feeding at 12 months CA.

Conclusion(s): Among EP children with moderate to severe BPD, oral aversion and tube feeding are common and demonstrate the importance of speech therapy during the first year of life. Caregiver education should include strategies to reduce the risk of oral aversion in children with moderate to severe BPD.

Table 1. Maternal and infant demographics, neonatal morbidities, and interventions by feeding status at 12 months corrected age
Note. All variables are presented as M ± SD unless otherwise specified. Feeding outcomes could not be determined for 16 of the 180 infants due to incomplete feeding data at 12 months corrected age.
Abbreviations: SGA, small for gestational age; PMA, postmenstrual age; IVH, Intraventricular hemorrhage; PVL, Periventricular leukomalacia; VP, ventriculoperitoneal, ROP, retinopathy of prematurity; anti-VEGF, anti-vascular endothelial growth factor; PDA, patent ductus arteriosus; NEC, necrotizing enterocolitis; BPD, bronchopulmonary dysplasia; CLD, chronic lung disease

Table 2. NICU growth and nutrition by feeding status at 12 months corrected age
Note. All variables are presented as M ± SD unless otherwise specified. Feeding outcomes could not be determined for 16 of the 180 infants due to incomplete feeding data at 12 months corrected age.
Abbreviations: TPN, total parenteral nutrition; RAM CPAP, respiratory airway management cannula continuous positive airway pressure; PO, per os (oral feeding); FEES, fiberoptic endoscopic evaluation of swallowing; GI, gastrointestinal; NG tube, nasogastric tube; G-tube, gastrostomy tube

Table 3. Feeding and respiratory status at 12 months corrected visit
Note. All variables are presented as M ± SD unless otherwise specified. Feeding outcomes could not be determined for 16 of the 180 infants due to incomplete feeding data at 12 months corrected age.
Abbreviations: CA, corrected age; NG tube, nasogastric tube; G-tube, gastrostomy tube; NC, nasal cannula