661 - Oral Feeding Performance at 34 Weeks Postmenstrual Age is Associated with Gastric Motility and Time to Achieve Full Oral Feeding

Publication Number: 1638.661

Emily Bordier, University of Texas Southwestern Medical School, Dallas, TX, United States; Lindsay Roblyer, University of Texas Southwestern Medical School, Dallas, TX, United States; Jijia Wang, University of Texas Southwestern Medical School, Dallas, TX, United States; Eric B. Ortigoza, UT Southwestern Medical Center, Dallas, TX, United States

Background: For preterm infants, time to achieve full oral feeding is associated with length of hospitalization. Oral motor function and swallowing are associated with gastric motor function, suggesting related autonomic nervous activity. Objective measures are needed to help us anticipate time to achieve full oral feeding to improve clinical management and discharge planning.

Objective: To determine the association between gastric motility, time to achieve full oral feeding, and oral feeding performance at 34 weeks postmenstrual age (PMA), as this is the expected time of physiologic readiness for oral feeding.

Design/Methods: In a longitudinal, prospective cohort study, we utilized electrogastrography (EGG) to measure % tachygastria, a gastric dysrhythmia indicative of gastric dysmotility, in preterm infants at 34 weeks PMA. Spearman rank correlation and multivariable linear regression models were used to determine the associations between % tachygastria at 34 weeks PMA, % oral intake at 34 weeks PMA, and days to achieve full oral feeding. Covariates were included as demographic factors (gestational age, birthweight, and biologic sex), factors at initiation of enteral feeding (time to initiate, type of feed/milk), and characteristics at 34 weeks PMA (level of respiratory support, type of feed/milk, fortification, nil per os (NPO), and continuous tube feeding status).

Results: Ninety-two infants were included in this study (64 infants had EGG data at 34 weeks PMA). Pre-prandial % tachygastria at 34 weeks PMA was not significantly associated with days to achieve full oral feeding (rs = 0.105, p = 0.417), but it was negatively associated with oral intake percentage at 34 weeks PMA (β = -6.299, p = 0.042) after adjusting for level of respiratory support. Oral intake percentage at 34 weeks PMA had a significantly positive association with time to achieve full oral feeding (β = -25.557, p < 0.001) after adjusting for GA and level of respiratory support.

Conclusion(s): 24-hour oral intake percentage at 34 weeks PMA may be a significant predictor of days to achieve full oral feeding and related length of hospitalization, if validated in future prospective studies. Gastric dysmotility (high % tachygastria) is associated with low 24-hour % oral intake at 34 weeks PMA, suggesting a potential maturation-dependent relationship. Further investigation at additional PMAs is needed.

Table 1: Participant Demographics and Characteristics
Note: Median (interquartile range) presented for continuous variables, and n (%) for categorical variables. Abbreviations: GA, gestational age at birth; MOM, mother's own milk; DHM, donor human milk; PMA, postmenstrual age, EGG, electrogastrography; cpm, cycles per minute; NC, nasal cannula; HFNC, high flow nasal cannula; CPAP, continuous positive airway pressure; HFJV, high frequency jet ventilation; NPO, nil per os (nothing by mouth); AN/H, alternate means of nutrition/hydration. Bolded items represent variables of interest in the study.

Figure 1: A) Preprandial tachygastria percentage is associated with oral feeding intake at 34 weeks PMA. B) Pre-prandial tachygastria percentage predicts oral feeding intake at 34 weeks PMA, after adjusting for level of respiratory support at 34 weeks PMA (p < 0.001, R2 = 0.575, adjusted R2 = 0.553).
A) There is a significant negative association (rs = -0.333, p = 0.008, 95% CI [-0.542, -0.086]) with 24-hour oral intake percentage at 34 weeks PMA.
B) Significantly negative association of log transformed 24-hour oral intake percentage at 34w6d PMA (β = -6.299, p = 0.042, 95% CI [-12.365, -0.233]), after adjusting for covariate level of respiratory support at electrogastrography (EGG) recording at 34 weeks PMA. Confidence bands represent 95% confidence intervals for the estimated regression line.

A) Oral feeding intake percentage at 34 weeks PMA is associated with days to achieve full oral feeding. B) Oral feeding intake at 34 weeks PMA predicts the number of days to achieve full oral feeds, after adjusting for GA and level of respiratory support at 34 weeks PMA (p = < 0.001, R2 = 0.901, adjusted R2 = 0.895).
A) Significant, negative association (rs = -0.611, p = < 0.001, 95% CI [-0.736, -0.447]) with 24-hour oral intake percentage at 34w6d PMA.
B) Significant association of days to full oral feeding with 24-hour oral intake percentage at 34 weeks, 6 days PMA (β= -25.557, p < 0.001, 95% CI [-34.166, -16.988]) after adjusting for covariates gestational age (GA) and level of respiratory support at electrogastrography (EGG) recording at 34 weeks. Confidence bands represent 95% confidence intervals for the estimated regression line.