High-flow nasal cannula oxygen and nasal continuous positive airway pressure and full oral feeding in infants with bronchopulmonary dysplasia

Objective To determine whether the time to achieve full oral feeding differed between infants with bronchopulmonary dysplasia (BPD) supported by nasal continuous positive airway pressure (nCPAP) compared with those supported by nCPAP and subsequently transferred to heated, humidified, high-flow nasal cannula oxygen (HHFNC). Design Two-cohort comparison. Setting Tertiary neonatal unit. Patients 72 infants, median gestational age 27 (range 24-32) weeks in the nCPAP group, and 44 infants, median gestational age 27 (range 24-31) weeks in the nCPAP/HHFNC group. Interventions Between 2011 and 2013, infants post extubation were supported by nCPAP and from 2013 infants were supported by nCPAP and then HHFNC. Main outcome measures The postnatal age at which oral feeds were first trialled and full oral feeds established. The length of respiratory support as either nCPAP or nCPAP/HHFNC and the total length of respiratory support and hospital stay were also determined. Subanalysis was undertaken of infants requiring respiratory support beyond 34 weeks postmenstrual age (PMA). Results The postnatal age at trial of first oral feeds was earlier in the nCPAP/HHFNC group (p=0.012), but infants were a shorter time on nCPAP compared with nCPAP/HHFNC (p=0.003). On subgroup analysis, the age to achieve full oral feeds was earlier in the nCPAP/ HHFNC group (p<0.001). Conclusions In infants with BPD who required respiratory support beyond 34 weeks PMA, use of nCPAP then HHFNC was associated with earlier establishment of full oral feeds. Consideration should be given to assessing stable BPD infants with regard to oral feeding while on CPAP.