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Background: Based upon the hypothesis that maturation of swallowing without respiratory inhalation is a fetal phenomenon prior to 24 weeks of gestation, we evaluated the efficacy and physiologic safety of buccal feeding by a traditional Indian feeding cup in gavage-fed preterm neonates. Methods: Ten neonates in transitional care units (mean BW = 2132g, range = 970 to 3551g; GA range = 31 to 40wks) who were in transition to nipple feeding from a gavage feeding were studied for their cardio-respiratory and oxygenation (by pulse-oximetry) status as well as for any adverse event (A/E) as evidenced by apnea (>15 secs), bradycardia (<80/min), desaturation (<85% on pulse-oximetry) or emesis. Neonates were fed expressed breast milk or special care formula by both an oro-gastric tube (gravity dependent technique for a baby in a supine posture) and by buccal feeding (administered by a skilled practitioner to a baby cradled in a neck supported posture in the care giver's lap. Partial nipple feedings were also evaluated in 4 gavage-fed babies (standard feed technique). Results: The mean duration of feedings are similar: 14.9±10.5SD min for the standard and 14.9±5.1SD min for buccal feed modes, respectively. The mean duration of sleep following either mode is also similar. Mean values for the cardio-respiratory and A/E data pre-, during, and post (30 min) feeding are listed below. (Table) These data show that buccal feeding is not associated with any adverse cardio-respiratory status and in fact adverse event episodes appear to be less frequent. Conclusions: Our observations confirm those previously noted in more mature low birthweight babies (clinical practice in several Indian neonatal centers) and illustrate the efficacy and the cardio-respiratory safety of buccal feed as an alternative feeding technique in the hands of skilled caregivers.
Schwoebel, A., Arbeter, T., Hollister, S. et al. Evaluation of an Alternative Buccal Feeding Technique in Gavage-Fed Preterm Neonates.
Pediatr Res45, 290 (1999). https://doi.org/10.1203/00006450-199904020-01726
