Clin Exp Pediatr.  2023 Jan;66(1):32-37. 10.3345/cep.2022.00780.

A thickened formula reduces feeding-associated oxygen desaturation and bradycardia in preterm infants

• Lee G
• Lee J
• Jeon GW
• Jun YH

• KMID: 2537280
• DOI: http://doi.org/10.3345/cep.2022.00780

Abstract

Background
Although preterm infants often experience desaturation or bradycardia during oral feeding, specific guidelines for its management are lacking. Purpose: This study aimed to investigate the effects of a commercial thickened formula (TF) on oxygen saturation and heart rate stabilization during oral feeding in preterm infants.
Methods
This retrospective study included 122 infants born at a median (interquartile range [IQR]) 31⁺⁶ weeks (29⁺⁴ −34⁺⁶ weeks) of gestation weighing 1,725 g (1,353–2,620 g) and fed commercial cornstarch-containing TF due to feeding-associated desaturation or bradycardia. We excluded infants fed TF to treat symptomatic regurgitation. Desaturation and bradycardia events were compared between 3 days prior to the change and 3 days after the change to TF. Desaturation and bradycardia were defined as SpO₂ <85% and heart rate <100 beats/min during or immediately after oral bottle feeding, respectively.
Results
The median (IQR) postmenstrual age and weight were 36⁺¹ weeks (34⁺⁶–38⁺⁰ weeks) and 2,395 g (2,160–2,780 g), respectively, at the time of change to TF. The frequency of desaturation significantly decreased after TF feeding (median [IQR]: 2.3 [1.3–3.3] events/day vs. 0.3 [0–1.7] events/day, P< 0.001). Bradycardia also decreased after TF feeding (0.3 [0–1] events/day vs. 0 [0–0.7] events/day, P=0.006). There were no cases of diarrhea or electrolyte abnormalities after TF feeding. Defecation frequency decreased (P=0.037), and polyethylene glycol was prescribed to 27% of the TF-fed infants. In a subgroup analysis of 16 infants with bronchopulmonary dysplasia, the frequency of desaturation was reduced (2.3 [1.8–3.8] events/day vs. 0.5 [0–1.5] events/day, P=0.042), and weight gain improved (22.5 [3.1–36.3] g/day vs. 41.3 [28.1–55.1] g/day, P=0.019), after TF feeding.
Conclusion
TF feeding significantly reduces oral feeding-associated oxygen desaturation and bradycardia in preterm infants. TF may be useful for stabilizing oxygen saturation and heart rate among preterm infants with difficulties in oral feeding.

Keyword

Infant nutritional physiological phenomena; Bottle feeding; Feeding behavior; Thickened