A thickened formula reduces feeding-associated oxygen desaturation and bradycardia in preterm infants

BACKGROUND: Although preterm infants often experience desaturation or bradycardia during oral feeding, specific guidelines for its management are lacking. PURPOSE: This study aimed to investigate the effects of a commercial thickened formula (TF) on oxygen saturation and heart rate stabilization during oral feeding in preterm infants. METHODS: This retrospective study included 122 infants born at a median (interquartile range [IQR]) 31(+6) weeks (29(+4) −34(+6) weeks) of gestation weighing 1,725 g (1,353–2,620 g) and fed commercial cornstarch-containing TF due to feeding-associated desaturation or bradycardia. We excluded infants fed TF to treat symptomatic regurgitation. Desaturation and bradycardia events were compared between 3 days prior to the change and 3 days after the change to TF. Desaturation and bradycardia were defined as SpO(2) <85% and heart rate <100 beats/min during or immediately after oral bottle feeding, respectively. RESULTS: The median (IQR) postmenstrual age and weight were 36(+1) weeks (34(+6)–38(+0) weeks) and 2,395 g (2,160–2,780 g), respectively, at the time of change to TF. The frequency of desaturation significantly decreased after TF feeding (median [IQR]: 2.3 [1.3–3.3] events/day vs. 0.3 [0–1.7] events/day, P< 0.001). Bradycardia also decreased after TF feeding (0.3 [0–1] events/day vs. 0 [0–0.7] events/day, P=0.006). There were no cases of diarrhea or electrolyte abnormalities after TF feeding. Defecation frequency decreased (P=0.037), and polyethylene glycol was prescribed to 27% of the TF-fed infants. In a subgroup analysis of 16 infants with bronchopulmonary dysplasia, the frequency of desaturation was reduced (2.3 [1.8–3.8] events/day vs. 0.5 [0–1.5] events/day, P=0.042), and weight gain improved (22.5 [3.1–36.3] g/day vs. 41.3 [28.1–55.1] g/day, P=0.019), after TF feeding. CONCLUSION: TF feeding significantly reduces oral feeding-associated oxygen desaturation and bradycardia in preterm infants. TF may be useful for stabilizing oxygen saturation and heart rate among preterm infants with difficulties in oral feeding.