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ORIGINAL RESEARCH article

Front. Pediatr.
Sec. Neonatology
Volume 12 - 2024 | doi: 10.3389/fped.2024.1496620
This article is part of the Research Topic Bronchopulmonary Dysplasia: Latest Advances-Volume II View all 5 articles

Use of Transpyloric Feeds in Extremely Low Birth Weight Infants at Risk of Severe Bronchopulmonary Dysplasia -A Single Center Experience

Provisionally accepted
Ahana Nagarkatti Ahana Nagarkatti 1Shikha Sarkar Shikha Sarkar 2Amirul Anuar Amirul Anuar 2Naveed Hussain Naveed Hussain 2*
  • 1 College of the Holy Cross, Worcester, United States
  • 2 Connecticut Children's Medical Center, Hartford, Connecticut, United States

The final, formatted version of the article will be published soon.

    Introduction: The incidence of severe BPD (sBPD), defined as needing oxygen or positive pressure at 36 weeks corrected gestational age (CGA), has remained unchanged. These infants are at risk for developing late pulmonary hypertension (LPHN) or needing surgical interventions such as Gastrostomy Tubes (GT) or Tracheostomy Tubes (TT). The finding of pepsin in the lungs of infants who were extremely low birth weight (ELBW) with sBPD has led to the speculation that gastroesophageal reflux (GER) and aspiration could contribute to their lung disease. Micro-aspiration-reducing strategies such as Transpyloric feeds (TpF) have not been well studied. Objectives: to compare ELBW infants with sBPD managed with or without TpF and determine the difference between the two groups for (i) illness severity, (ii) LPHN, (iii) need for GT, and (iv) TT; the secondary aim to study the TpF group to (i) evaluate the change in Respiratory Severity Score (RSS) before and after TpF, and (ii) evaluate the time taken to affect the change in RSS. Methods: In this retrospective study there were 229 ELBW infants with sBPD (78 in the TpF group, 151 in the non-TpF group). SPSS software was used for univariate analyses. Results: There was no difference in sex or race. TpF group had (i) a lower BW, GA, higher severity of illness (ii) higher incidence of LPHN (p<0.05), (iii) higher need for GT (p<0.001) and TT (p<0.001). In the TpF group, 60 who were on TpF for pulmonary protection from micro aspiration (lung protection group), had significantly improved RSS (p<0.05), and symptoms within 45 days in 57 out of 60 infants (95%). They improved their respiratory status by 14 days, and 80% of responders could be identified by 21 days after initiation. In the 18 that TpF was started for documented airway protection (airway protection group), there was a higher need for GT or TT. Conclusions: TpF could play an essential role in the management of ELBW infants with sBPD. Considering the limitations of a single center retrospective study, prospective randomized control trials are needed to confirm these findings.

    Keywords: ELBW (Exterme low birth weight infants), transpyloric feeding, SBPD, LPHN, gastrostomy tube, Tracheostomy tube

    Received: 15 Sep 2024; Accepted: 18 Nov 2024.

    Copyright: © 2024 Nagarkatti, Sarkar, Anuar and Hussain. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Naveed Hussain, Connecticut Children's Medical Center, Hartford, 06106, Connecticut, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.