1. Feeding in Very Low Birth Weight neonates on Vapotherm versus CPAP
Rashmi Mathew MBBS, Gary Stahl MD, Judy Saslow, MD, Vishwanath Bhat MD, Alla Kushnir MD
Department of Pediatrics, Division of Neonatology, Cooper University Hospital, Camden, NJ
Abstract
Background: Respiratory distress syndrome (RDS) is a significant problem associated with prematurity. New advances in the field of neonatology and in treatment of RDS improved survival and decreased complications such as intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP). Early nutrition is an important factor, which may help decrease common morbidities seen in the NICU and shorten the length of stay. While effects of early nutrition on preterm infants have been extensively studied, few studies have looked at the effect of specific noninvasive respiratory devices on initiation of feeds. Vapotherm (VP) is a device that provides heated high flow air with 100% humidity. Nasal Continuous Positive Airway Pressure (NCPAP) provides continuous positive pressure. Objective: To compare effects of NCPAP versus VP on initiation of feeding and achievement of full feeds in very low birth weight infants Design/Methods: IRB approved, retrospective review of 238 preterm babies ≤1500gms and ≤32 weeks who were admitted to the neonatal intensive care unit from 1/1/2008 to 12/31/2012. All patients were either placed on VP or NCPAP or both as primary respiratory support for respiratory distress. Primary outcomes were the time to initiation of feeds and oral feeds, and duration until reaching full feeds and full oral feeds. These outcomes were compared between the two groups of those on CPAP and those on VP. Results: A total of 252 infants qualified for the study. Patients who were on CPAP alone were started on feeds (p=0.04) and attained full feeds (p=0.005) earlier. However, babies on CPAP had higher gestation age (GA) and birth weight (BW), and when adjusted for in multivariate analysis the significance disappeared. Neonates on CPAP were not offered oral (PO) feeds and therefore did not reach full PO feeds while on CPAP. There was no statistical significance between those on CPAP alone, VP alone, or who used both modes of respiratory support in the time it took to initiate feeds (p=0.33) or reach full feeds (p=0.15). PO feeds were started on average at 1.3 Liters and reached full PO feeds at 0.3Liters (room air to 5L) VP. Conclusion: Use of CPAP appeared beneficial in early initiation of feeds, however, when adjusting for GA and BW there was no difference between different modes of non-invasive respiratory support. Use of VP facilitated initiation and reaching full PO as compared to CPAP.
Modes of Noninvasive Ventilation and Patient Characteristics
Modes of Noninvasive Ventilation and Feeding Description
Methods
IRB approved, retrospective review of 252 preterm babies ≤1500gms and ≤32 weeks who were admitted to the neonatal intensive care unit from 1/1/2008 to 12/31/2012.
All patients were either placed on VP or NCPAP or both as non-invasive respiratory support for respiratory distress.
Primary outcomes were the time to initiation of feeds and oral feeds, and duration until reaching full feeds and full oral feeds.
These outcomes were compared between the three groups of those on CPAP and those on VP.
Comparisons between VP and NCPAP were performed using ANOVA, Mann-Whitney, and Ordinal Logistic Regression.
CPAP VP
CPAP +VP
N= 19
N= 214 p
Birth Weight, grams
1201.6
1116.5
977.2
<0.001*
Gestational age, weeks
30.7
28.5
27.8
Gender, n(%)
Male
13(68)
10(53)
106(51)
0.29
Race, %
Caucasian
6 (32)
4 (21)
68 (32)
African-American
10 (53)
95 (44)
Hispanic
2 (11)
3 (16)
43 (20)
Mode of delivery, n (%)
Vaginal
11 (58)
104 (49)
0.73
Surfactant administered, n (%)
13 (68)
137 (64)
0.001*
Need for intubation, n (%)
16 (84)
163 (76)
Postnatal Steroids n (%)
42 (20)
0.01*
Use of Caffeine
15 (79)
19 (100)
214 (100)
CPAP VP
CPAP +VP
N= 19
N= 18
N= 214 p
Day at start of feeds, mean (SD)
2.6 (0.68)
5.6 (6.13)
6.2 (6)
0.4
Day full feeds reached, mean (SD)
12.5 (4)
24.2 (16.4)
24.6 (15.6)
0.005*
Day at start of oral feeds, mean (SD)
16.9 (7.8)
35.8 (22)
40.1 (19)
<0.001*
Day full oral feeds reached, mean (SD)
32.2 (12.8)
60.8 (34.3)
59.5 (27)
Results
A total of 252 infants qualified for the study. Patients who were on CPAP alone were started on feeds (p=0.04) and attained full feeds (p=0.005) earlier.
However, babies on CPAP alone were had higher gestation age (GA) and birth weight (BW) and when these variables were included in multivariate analysis the significance disappeared.
In neonates < 30 weeks were not offered oral (PO) feeds and therefore did not reach full PO feeds while on CPAP.
There was no statistical significance between those on CPAP alone, VP alone, or used both modes of respiratory support in the time it took to initiate feeds (p=0.33) or reach full feeds (p=0.15).
PO feeds were started at an average of 1.3 Liters and reached full PO feeds on average at 0.3Liters (0 to 5L) VP.
Introduction
Respiratory distress syndrome (RDS) is a significant problem associated with prematurity. Early nutrition is an important factor, which may help decrease common morbidities seen in the NICU and shorten the length of stay. While effects of early nutrition on preterm infants have been extensively studied, few studies have looked at the effect of specific noninvasive respiratory devices on early initiation of feeds. Vapotherm (VP) is a device that provides heated high flow air with 100% humidity. Nasal Continuous Positive Airway Pressure(NCPAP)provides continuous positive pressure. Both are used in the NICU for non-invasive respiratory support.
* p<0.05
Amount of Vapotherm Flow when Oral Feeds were started
Amount of Vapotherm Flow when Full Oral Feeds were Reached
Conclusions
Use of CPAP appeared beneficial in early initiation of feeds, however, when adjusting for GA and BW there was no difference between different modes of non-invasive respiratory support. Use of VP facilitated initiation and reaching of full oral feeding as compared to CPAP.
Objective
To compare effects of NCPAP versus VP on initiation of feeding and achievement of full feeds in very low birth weight infants.
References
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