Oral Feeding and Aspiration Risk in Preterm Infants Receiving Nasal High-Flow Respiratory Support: A Cross-Sectional Study

Abstract To objectively assess aspiration risk with oral feeding during nasal high-flow (NHF) and to correlate NHF rate and presence and depth (degree) of Oropharyngeal Aspiration (OPA). Cross-sectional study. Single-center, Level III, neonatal unit. Infants born preterm (< 37-weeks gestational age [GA]), aged ≥ 35-weeks to 4-weeks corrected gestational age (CGA) at an oral feeding trial, whilst receiving NHF (> 1 L/min), demonstrating oral feeding readiness cues, managing oral secretions, and clinically stable. Participants underwent a clinical feeding evaluation (CFE) and videofluoroscopic swallow study (VFSS). Aspiration status was determined using the Penetration-Aspiration Scale (PAS) on VFSS. Flow rate (L/min), weight-adjusted flow rate (L/kg/min), and fraction of inspired oxygen (FiO 2 ) were recorded at CFE and VFSS, with PAS data used for analysis. Twenty preterm infants, (13 males) were recruited. They were born at 24 weeks + 0-days to 36-weeks + 6-days GA, and aged 34-weeks + 6-days to 42-weeks + 5-days CGA at their CFE. One infant had suspected aspiration on CFE, and two had silent aspiration confirmed on VFSS. PAS ranged from 1 to 8 (median 2.00, interquartile range 1.00–2.00). Unadjusted and weight-adjusted flow rates at VFSS were 4–8 (mean±standard deviation 5.60 ± 1.27) L/min and 1.2–3.88 (2.24 ± 0.61) L/kg/min, respectively. Level of laryngeal penetration-aspiration was not correlated with flow rate (L/min; p = 0.11) but significantly inversely correlated with weight-adjusted flow rate (L/kg/min; p = 0.01). These early findings suggest that it may be safe to orally feed some clinically stable preterm infants receiving NHF under controlled conditions. Aspiration risk should be based upon patient-specific factors and not just from receiving NHF. However, additional research is needed.