Acute respiratory effect of transpyloric feeding for respiratory exacerbation in preterm infants

Objectives: Gastroesophageal reflux may exacerbate chronic lung disease in preterm infants. We evaluated the short-term effects of transpyloric feeding on respiratory status in preterm infants during mechanical ventilation. Methods: We retrospectively collected data from the hospital information management system. To evaluate the effect of transpyloric feeding on oxygenation, we compared changes in SpO(2)/FiO(2) ratios before and after commencing transpyloric feeding by a piecewise linear regression model. Results: We examined 33 infants (median gestational age, 25.4 weeks; median birth weight, 656 g) who underwent transpyloric feeding. All tubes were placed at the bedside without fluoroscopy. No cases of unsuccessful placement, gastroduodenal perforation, or tracheal misinsertion occurred. Transpyloric feeding began at a median age of 18 (interquartile range, 15-23) days. Mean SpO(2)/FiO(2) (+/- SD) ratios were 391 (+/- 49), 371 (+/- 51), 365 (+/- 56), and 366 (+/- 53) 72-96 h before, 0 -24 h before, 48-72 h after, and 96-120 h after starting transpyloric feeding, respectively. The rate of change per hour of SpO(2)/FiO(2) ratios increased 48-120 h after compared with 0-96 h before transpyloric feeding (0.03 [95% confidence interval, -0.10 to 0.17] vs. -0.29 [- 0 .47 to - 0 .12]) (p=0.007). No apparent changes occurred in the mean airway pressure, amplitude pressure, or pCO(2). Conclusions: Transpyloric feeding during mechanical ventilation can prevent the deterioration of oxygenation without major complications at the stage of respiratory exacerbation in preterm infants.