EFFECTS OF BOTTLE-FEEDING AND 2 DIFFERENT METHODS OF GAVAGE FEEDING ON OXYGENATION AND BREATHING PATTERNS IN PRETERM INFANTS

Objective: To determine the effect of bottle feeding, as compared to t wo methods of gavage feeding, on apnoea, bradycardia and oxygen desatu ration frequency. Patients: Thirty preterm infants breathing room air; gestational age 28.6 +/- 2.1 weeks at birth and 34 +/- 1.4 weeks at s tudy (mean +/- SD). Methods: Nine-hour recordings of pulse oximeter sa turation (SpO(2)), pulse waveforms, electrocardiogram, breathing movem ents and nasal airflow. Administration of 21 +/- 1.5 ml/kg of milk/fee d in 3-h intervals using three different feeding techniques in random order: bottle feeding, bolus gavage feeding, and slow gavage feeding ( 1 h). Analysis of recordings for apnoeas (greater than or equal to 4 s , bradycardias (heart rate < 2/3 of baseline), and episodic desaturati on (SpO(2) less than or equal to 80%). Results: There were three times more desaturations with bottle feeding than with bolus gavage feeding (p < 0.001), but no further reduction with slow gavage feeding. With all three feeding techniques, there were significantly more desaturati ons in the hour when the feeds were given than during the following 2 h. The deleterious effects of bottle feeding were most evident during the hour of feeding, but desaturation frequency remained significantly higher than with gavage feeding during the following 2 h. There was n o significant effect of feeding technique on the frequency of apnoea o r bradycardia. Conclusions: Preterm infants who are normally oxygenate d in room air may have significant desaturation during bottle feeding. Such desaturation can be effectively reduced by gavage feeding. Slow gavage feeding offers no advantage over bolus gavage feeding with resp ect to the avoidance of hypoxaemia.