Speech Pathology Department, Gold Coast University Hospital, Gold Coast, Australia.
Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD, 4215, Australia.
Dysphagia. 2020 Jun;35(3):443-454. doi: 10.1007/s00455-019-10047-4. Epub 2019 Aug 26.
To investigate oral-feeding practices for infants and children receiving nasal continuous positive airway pressure (nCPAP) and high-flow nasal cannula (HFNC) respiratory support. A survey was sent to Neonatal (NICU) and Paediatric Intensive Care Units (PICU) in Australia and New Zealand to explore feeding practices for infants/children receiving nCPAP and HFNC, including criteria for commencing/recommencing oral feeding, frequency of oral feeding, strategies to assist oral feeding, assessment tools, reasons for not orally feeding, existence of written guidelines and staff opinion regarding feeding safety. Seventy-seven individual survey responses were analysed from 49 units from 38 hospitals. Most units (53%) reported that infants/children are 'never or rarely' fed orally on nCPAP compared with 21% on HFNC. 2% of units 'often' feed infants on nCPAP whilst 38% 'often' feed on HFNC. Oral feeding on HFNC is more likely to occur in a NICU (100% sometimes/often) than a PICU (55% sometimes/often) setting. Only 4% of infants are often fed orally on nCPAP versus 54% on HFNC in NICUs. Eighty percent of all units reported they do not have a written policy or guideline that includes feeding recommendations for infants/children receiving non-invasive respiratory supports. Oral feeding for infants and children receiving nCPAP and HFNC is occurring in NICU and PICUs in Australia and NZ. There is varied opinion regarding the safety of oral feeding on nCPAP and HFNC. Further research is recommended, including studies with instrumental assessment of swallow safety and investigation of short and long-term feeding outcomes, to guide clinicians in this area of practice.
调查接受经鼻持续气道正压通气（nCPAP）和高流量鼻导管（HFNC）呼吸支持的婴儿和儿童的口腔喂养实践。向澳大利亚和新西兰的新生儿（NICU）和儿科重症监护病房（PICU）发送了一份调查，以探讨接受 nCPAP 和 HFNC 的婴儿/儿童的喂养实践，包括开始/重新开始口服喂养的标准、口服喂养的频率、辅助口服喂养的策略、评估工具、不进行口服喂养的原因、是否有书面指南以及工作人员对喂养安全性的意见。从 38 家医院的 49 个单位分析了 77 份单独的调查答复。大多数单位（53%）报告说，与 HFNC 相比，接受 nCPAP 的婴儿/儿童“很少或从不”进行口服喂养。2%的单位“经常”给婴儿喂 nCPAP，而 38%的单位“经常”给 HFNC 喂食。在 NICU 中，HFNC 更有可能进行口服喂养（100%有时/经常），而在 PICU 中则为 55%（有时/经常）。在 NICU 中，只有 4%的婴儿经常接受 nCPAP 喂养，而 54%的婴儿经常接受 HFNC 喂养。80%的单位报告说，他们没有关于接受非侵入性呼吸支持的婴儿/儿童喂养建议的书面政策或指南。澳大利亚和新西兰的 NICU 和 PICU 都在为接受 nCPAP 和 HFNC 的婴儿和儿童进行口服喂养。对于 nCPAP 和 HFNC 上的口服喂养安全性，存在不同的意见。建议进一步研究，包括使用仪器评估吞咽安全性的研究和调查短期和长期喂养结果，以指导该领域的临床医生。
