344 - Diffuse white matter abnormality is a risk factor for delayed full oral feedings in preterm infants born at ≤32 weeks gestational age

Publication Number: 344.4421

Shipra Jain, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Ting Ting Fu, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Nehal A. Parikh, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Safe oral feeding relies on the coordination of the suck-swallow-breathe reflex, controlled by the brainstem and modulated by the motor cortex. Brain MRI can reveal structural abnormalities, such as white matter injury, which may impair feeding coordination or ability. Identification of risk factors for delayed full oral feedings in preterm infants could facilitate earlier decisions regarding discharge to home with gastrostomy/nasogastric tube feeding.

Objective: To examine whether brain abnormalities observed on MRI at term-equivalent age (TEA) are associated with achievement of delayed full oral feedings (>40 weeks post-menstrual age [PMA]) in preterm infants.

Design/Methods: This secondary analysis includes all 395 infants born at or before 32 weeks gestational age, prospectively enrolled in the Cincinnati Infant Neurodevelopment Early Prediction Study (CINEPS). Primary and secondary exposures were objectively defined diffuse white matter abnormality (DWMA) volume and severe global brain abnormality score (GBAS) with scores > 12, as measured on MRI at 39-44 weeks PMA by an automated software and a single blinded neuroradiologist respectively. The primary outcome was inability to achieve full oral feeding (~120 ml/kg/day for 48 hours) by 40 weeks PMA. Baseline characteristics and neonatal outcomes were compared between groups with and without delayed feedings. Logistic regression models assessed associations between neuroimaging findings and delayed feedings, adjusting for several confounders: gestational age (GA), necrotizing enterocolitis (NEC) stage 2/3, bronchopulmonary dysplasia (BPD) severity (Stage 0-3), severe intraventricular hemorrhage (IVH) grade 3/4, and PMA when MRI was performed.

Results: Of 395 infants, 90 did not achieve full oral feeding by 40 weeks PMA. These infants had younger GA, lower birth weights, and higher incidences of BPD grade 3, NEC stage 2/3, IVH grade 3/4, pulmonary hypertension, retinopathy of prematurity, and sepsis (Table 1). In adjusted models, both DWMA (Table 2) and severe GBAS (Table 3) were significantly associated with delayed full oral feeding achievement by 40 weeks PMA with odds ratio (95% CI) of 1.66 (1.13-2.43) and 3.46 (1.29-9.08) respectively.

Conclusion(s): In a large multisite cohort of preterm infants, DWMA extent and severe GBAS on TEA brain MRI were significantly associated with delayed achievement of full oral feeding. Addition of other advanced neuroimaging biomarkers on brain MRI at TEA may facilitate accurate prognostic models to identify infants at higher risk for poor oral feeding.

Table 1: Prenatal and postnatal characteristics of preterm infants with and without delayed achievement of full oral feedings by 40 weeks post menstrual age.


Table 2: Association between diffuse white matter abnormality (DWMA) and delayed achievement of full oral feedings in preterm infants by 40 weeks post-menstrual age.


Table 3: Association between global brain abnormality score and delayed achievement of full oral feedings in preterm infants by 40 weeks post-menstrual age.