Table 1.
Study characteristics
| Author, year | Study design and setting | Participants (sample size, age and condition) | Type of respiratory support, flow/pressure | Details of oral feeding | Main outcomes |
|---|---|---|---|---|---|
| Bapat 2019 [23] | Quality improvement project (non-contemporary cohort comparison study); NICU | 279 infants < 32 + 6 weeks GA (198 had BPD); baseline group 92 infants (63 had BPD); SIMPLE group 187 infants (135 had BPD) | CPAP (H2O not reported) | Oral feeding on CPAP; Guideline for feeding strategies on respiratory support; once a day oral feeding by occupational therapist, intensive cautious early feeding opportunities. | Days to full enteral feeding; days to first oral feeding; days to full oral feeding; ventilation duration; growth milestones; discharge milestones including LOS |
| Dalgleish 2016 [10] | Quality improvement project (non-contemporary cohort comparison study); NICU | 196 infants born < 32 weeks with respiratory morbidity |
CPAP (cmH2O not reported) HFNC> 1.5 L/min |
Cohort 1: No oral feeding on NIV = 91; Cohort 2: Oral feeding on NIV = 105; Oral feeding on nCPAP as per novel algorithm ‘Eating in SINC: Safe Individualised Nipple-Feeding Competence’ | GA at first oral feed; days of respiratory support; respiratory support at first NF; LOS; safety |
| Dumpa 2020 [24] | Retrospective cohort study; NICU | 99 infants < 32 weeks GA | CPAP 5-8cmH2O | Group 1 (oral feeding commenced on CPAP) = 39; Group 2 (oral feeding commenced when off CPAP); objective oral feeding assessment developed by NICU staff. | Duration to achieve full oral feeding; LOS; respiratory morbidities |
| Ferrara 2017 [14] | Prospective cohort study; NICU |
7 infants with a PMA > 34 weeks 6 preterm, 1 term (34.1–43.2 weeks CGA) |
CPAP 5cmH2O LFNC 1 L/min |
Oral feeding on CPAP; Infant swaddled positioned in a sitting position in a tumbleform infant seat, bottle offered for 90 s by a single feeding and swallowing specialize. | Incidence of mild and deep laryngeal penetration, aspiration and nasopharyngeal reflux on VFSS |
| Glackin 2017 [25] | Randomised control trial; NICU |
44 infants born before 30 weeks nCPAP = 22; HFNC = 22 |
nCPAP (cmH2O not reported, stated ‘current setting’); HFNC commencing at 7 L/min | Oral feeding on CPAP and HFNC; Oral feeds offered in both groups at least once every 72 h and additional feeds offered when infants demonstrated feeding cues. | Duration to first oral feed; duration to full oral feeds; duration of resp. support; CNLD; LOS; episodes of apnoea |
| Hanin 2015 [26] | Retrospective cohort study; NICU | 53 infants with BPD 37-42wks PMA; | nCPAP 6-8cmH2O | Orally fed on nCPAP = 26; Gavage fed on nCPAP =27; All oral feedings were done by a trained neonatal OT; clinical assessment completed prior to initiation of feeding therapy; based of SOFFI method; oral feeding session no more than 30mins, one session per day, 3–5 times per week. | Duration to full oral feeds; LOS; duration of nCPAP; safety metrics; readmission rate |
| Jadcherla 2016 [27] | Prospective case control study; NICU | 38 infants with BPD 28 + 0.7wks GA; 39-43wks CGA at evaluation; nCPAP = 9; NC = 19; RA = 10 | nCPAP 6-8 cm H2O; NC 0.1–2.0 L/min | Graded sterile water infusions via syringe of 0.1, 0.3 and 0.5 mL to the pharynx for infnats on CPAP. | Effects of pharyngeal stimulation on the initial and terminal pharyngoesophageal and respiratory responses |
| La Tuga 2019 | Retrospective case control study; NICU | 243 infants < 32 weeks GA who required CPAP at 32 weeks PCA | CPAP (cmH2O not reported) |
No CPAP first oral feed GA 27 (24–32) wks; CPAP first oral feed GA 26 (23–32) wks 31% (n = 76) received first oral feed on CPAP; Oral feeding defined as any feeding taken by mouth > 5 mL |
Length of stay; duration of resp. support; age at first oral feed; age at full oral feeds; duration to full oral feed; aspiration pneumonia |
| Leder 2015 | Prospective cohort study; NICU & adult ICU | 100 participants: 50 neonates (CGA range 33w7d-49w3d) & 50 adults | HFO2-NC 2-3 L/min | Oral feeding on HFNC. 17 neonates had oral feeding. Decisions to initiate oral feeding made jointly by neonatology and nursing using criteria. | Successful initiation of oral feeding; age at initiation of oral feeds |
| Leibel 2020 [33] | Randomised control pilot study; NICU | 25 infants born < 28 weeks GA, 34 weeks PMA, requiring CPAP or HFNC’; CPAP n = 12; HHHFNC n = 13 | CPAP >5cmH2O; HHHFNC > 5 L/min | Infants on CPAP were placed on LFNC (up to 2 L/min) for oral feeding, infants on HHFNC had flow reduced to 2 L/min for oral feeding | Days to full oral feed; weight gain; feeding type; feeding intolerance; NIV support at end of trial; incidence of CLD; PMA at conclusion of trial |
| Leroue 2017 [28] | Retrospective cohort study; PICU | 562 children older than 30 days to > 10 years (median age 2 yrs) requiring NIPPV, majority had a primary diagnosis of bronchiolitis or viral pneumonia | NIPPV = HHFNC, CPAP, BiPAP, AVAPS; CPAP or bilevel support 6-8cmH2O; HHFNC (flow rate/s not reported) | Oral feeding on NIPPV. 305 (54%) had oral intake. | Early EN; time to goal EN rate; adequacy of EN; frequency of EN interruptions > 6 h; AEs |
| Shadman 2019 [29] | Retrospective cohort study; intensive and general care units, children’s hospital | 123 children aged 1 to 24 months with bronchiolitis treated with HFNC | HFNC (flow rate/s not reported) | Oral feeding on HFNC. 78 (63%) were fed: 50 (41%) were exclusively orally fed and 28 (23%) had mixed oral and tube feeding. | Time to discharge after HFNC cessation; aspiration; intubation after HFNC; seven-day readmission |
| Shetty 2016 [8] | Retrospective cohort comparison study; NICU | 116 infants with BPD (24-32wks GA); nCPAP =72; nCPAP/HHFNC =44 | CPAP 4-6cmH2O; HHFNC 2-8 L/min | Oral feeding on HFNC (no oral feeding on CPAP); Infants on HFNC were referred to SLT service from 34 weeks GA to assess readiness to cope with oral feeding. | Age at first oral feed; age at full oral feeds; duration and type of resp. support; LOS |
| Shimizu 2019 [30] | Retrospective case control study; NICU | 45 infants (< 34 weeks PMA; GA 23.1–39.6 weeks GA) with very low birth weight and chronic lung disease | HFNC 2 L/kg/min | Oral feeding on HFNC n = 11 (GA 27.4; 23.1–32.0 weeks); oral feeding without HFNC n = 34 (31.2; 23.7–39.6 weeks); Oral feedings offered to infants with stable breathing after 34 weeks PMA, after oral feeding skill evaluation by physical therapists. | Duration to first oral feed; duration to full oral feeds; clinically significant aspiration pneumonia |
| Slain 2017 [9] | Retrospective cohort study; PICU | 70 children < 24 months (median age of 5 months) with bronchiolitis | HFNC 2-4 L/min; 5-6 L/min; > 7 L/min | Oral feeding on HFNC; 89% fed orally. | Incidence of feeding-related AEs; LOS; duration of HFNC |
| Sochet 2017 [31] | Prospective cohort study; PICU | 132 children (1 month to 2 yrs) with bronchiolitis | HFNC 4-13 L/min (0.3–1.9 L/kg/min) | Oral feeding on HFNC; 97% fed orally. | Incidence of aspiration-related respiratory failure |
nCPAP nasal continuous positive airway pressure, HFNC/HHFNC (humidified) high flow nasal cannula, HFO2-NC high flow oxygen nasal cannula, NC nasal cannula, NIPPV nasal intermittent positive pressure ventilation, BiPAP bilevel positive airway pressure, AVAPS average volume assured pressure support, RA room air, GA gestational age, CGA corrected gestational age, PMA postmenstrual age, PCA post-conceptual age, BPD bronchopulmonary dysplasia, AEs adverse events, LOS length of stay, EN enteral nutrition, VFSS videofluoroscopic swallow study, SOFFI Supporting Oral Feeding for Fragile Infants [32]