Exploring the risk of aspiration and its influence on oral feeding decision-making in infants receiving Nasal High Flow respiratory support (NHF).

Background Infants requiring NHF have impaired respiration and increased work-of-breathing at baseline. This impacts their ability to co-ordinate airway closure during oral (breast and bottle) feeding placing them at increased risk of laryngeal penetration and/or aspiration5. Beyond the risks associated with impaired breathing-swallowing co-ordination, is the impact of NHF on the swallow. As this is unknown6 some clinicians choose to delay the introduction of oral feeding until the infant has stopped NHF. However, delaying feeding has been linked to medical and neurodevelopmental consequences6,7 such as prolonged hospital stays, persistent feeding disorders6 and impaired infant-parent attachment and bonding9. Research question What is the risk of aspiration when orally feeding infants receiving NHF and how can clinicians be supported in their decision to introduce oral feeds? Aims and objectives This fellowship aims to explore the risk of orally feeding infants receiving NHF through three work packages (WP): Conducting an updated SR of existing evidence and guidance for orally feeding infants receiving NHF (WP1) Creating a decision-making framework, for healthcare professionals (HCP), deciding to orally feed infants receiving NHF (WP2) Investigating the clinical aspiration risk (laryngeal penetration and aspiration) detected by Video-fluoroscopic Swallow Study (VFSS) using the Penetration-Aspiration Scale (PAS) during oral feeding in infants receiving NHF (WP3) Investigating whether frequency and depth of aspiration is correlated with oxygen flow rate (WP3) Exploring parents' and staff's experiences and perceptions of risk when orally feeding infants receiving NHF (WP3) Methods WP1: updated SR, to identify new and existing evidence and guidelines, for orally feeding infants receiving NHF, to inform the topic guide in WP2. WP2: decision-making framework, for HCP, initiating oral feeding for infants receiving NHF, developed using semi-structured interviews and eDelphi. WP3: concurrent mixed-methods study exploring the risks of orally feeding infants receiving NHF. Anticipated Impact and Dissemination The findings of this research project will be shared through, national, and international conferences, publications in open-access research journals, professional magazines, Bliss (charity) newsletter and an infographic to be shared on Bliss and professional networks websites and social media. Regular updates will be shared via a dedicated website and X profile. Short-term impact: Parents and neonatal staff will learn more about orally feeding infants receiving NHF and experience the benefit of sharing their experiences with the researcher during interviews and PPIE activities. Medium-term impact: Results will increase awareness of the risks associated with orally feeding infants receiving NHF as well as parents' experiences. The decision-making framework may impact how NNUs, across the UK and internationally, manage oral feeding for infants receiving NHF which in turn is expected to result in shorter hospital stays and improved parent wellbeing and quality of life. Long-term impact: It is anticipated that study results, together with the decision-making framework, will have a positive impact on infant feeding and respiratory outcomes. Greater professional understanding of the risks associated with orally feeding infants receiving NHF and the development of a decision-making framework will reduce the total healthcare cost of neonatal hospital stays and support management of these babies in community health services.