Survey of Oral Feeding Practices Amongst Health Care Professionals for Infants Receiving Nasal Continuous-Positive Airway Pressure (nCPAP) and High Flow Nasal Canula (HFNC) Respiratory Support in the United Kingdom (UK).

Abstract

There is international uncertainty and little guidance regarding oral feeding on nasal continuous positive airway pressure (nCPAP) and high-flow nasal cannula (HFNC) respiratory support. The aim of this study is to investigate current practice in the UK when deciding to offer oral feeds to infants on nCPAP/HFNC. A novel survey was designed and conducted using Qualtrics. Purposive sampling was used to recruit participants in speech and language therapy, medicine and nursing via professional associations. Participants completed the 41-item survey which explored oral feeding practices for infants on nCPAP/HFNC. The survey included closed-choice and open-ended questions. Descriptive statistics using SPSS, were used to analyse quantitative findings. A frequency count and thematic analysis were used to describe qualitative data. 103 responses were analysed. Regarding frequency of oral feeding on nCPAP, most respondents (45%) never fed; 30% rarely fed; 21% sometimes fed; 3% often fed, and 1% always fed (n = 73). Regarding HFNC, most respondents (48%) sometimes fed; 23% often fed; 1% always fed and 28% never or rarely fed (n = 69). 58% of respondents followed no guidelines when making decisions regarding oral feeding on nCPAP/HFNC, and 42% did or had guidelines in development (n = 83). Qualitative analysis identified the importance of the multidisciplinary team (MDT), infant readiness and the evidence-base when orally feeding an infant on nCPAP/HFNC. A continuum of conflict was acknowledged ranging from agreement amongst the MDT to disagreement within and between disciplines. More clinicians feed on HFNC than on nCPAP and there is little in the way of guidelines to support decision-making leading to variation in practice. Further research is recommended, including empirical studies using instrumental assessment of swallow safety, to guide clinicians with their decision-making.