Grant: Project Grant

In Canada, 8% of all babies are born prematurely. To survive, they need help with breathing either with high oxygen and/or a machine such as respirator. However, both high oxygen and respirator can damage babies' lungs. To decrease lung injury, we use less invasive machine called continuous positive airway pressure (CPAP) or place them on Humidified Heated High Air Flow via Nasal Cannula (HHFNC). Feeding by mouth is also a big challenge for premature babies. When very small, they are fed via a tube placed in their stomach through mouth or nose. Usually, babies are ready to take small milk volumes by mouth after 32 wk of gestation (full-term = 40 wk). Health care providers worry that if babies are breast or bottle-fed while on CPAP machine or on HHFNC, they might inhale milk in their lungs, which could make them very sick. Based on our preliminary data, we hypothesize that it is safe to breast/bottle-feed babies while they are needing help with breathing. In this research proposal, we will extend our studies from pilot to a larger number of babies to examine if it is, indeed, safe to feed them orally while they are being helped via CPAP or HHFNC. We will use our feeding protocol known as Safe Individualized Nipple-feeding Competence protocol, where we increase oral feeds starting at only 5% of the total volume and gradually increase it to full breast/bottle intake. We plan to record and analyze cardiac and respiratory responses, and blood oxygen levels as the babies progress through increasing volumes of oral feeding while still on CPAP or HHFNC. We believe that starting smaller oral volumes of feeds and gradually increasing them, 1) the infants will learn to coordinate breathing and feeding skills leading to early discharge home, 2) less home-tube feeding, 3) improved overall development, 4) promote parent-baby interaction and 5) reduce health care costs. Our study has the potential to change the current way how we manage respiratory care in premature infants.