678 - Prevalence and clinical impact of gaseous distension in preterm neonates receiving non-invasive respiratory support

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 678
Publication Number: 678.443

Logan G. Hart, New York University Grossman School of Medicine, New York, NY, United States; Pradeep Mally, New York University Grossman School of Medicine, NEW YORK, NY, United States; Kristyn A.. Pierce, New York University Grossman School of Medicine, New York, NY, United States; Sean M. Bailey, New York University Grossman School of Medicine, New York, NY, United States

Presenting Author(s)

Logan G. Hart (he/him/his)

Medical Student
New York University Grossman School of Medicine
New York, New York, United States

Background: Non-invasive ventilation (NIV) reduces morbidity and mortality relative to invasive mechanical ventilation (IMV) in caring for preterm neonates with respiratory distress syndrome. A side effect of NIV is gaseous distension, which can lead to feeding intolerance, respiratory decompensation, and gastric perforation. Prior studies report wide ranges for the incidence of benign gaseous distension during NIV use, however, the prevalence of distension and its role in the frequency of feed disruption, radiographs, or emesis has not been fully explored.

Objective: This study’s primary objective is descriptive analysis of the prevalence of benign gaseous distension for various ventilatory support use, including minimal support (MS) on nasal canula or room air, during routine care of preterm neonates. The secondary objective is descriptive analysis of adverse events associated with gaseous distension such as feed interruption, ventilatory change, radiographs ordered, and emesis.

Design/Methods: Retrospective chart review of preterm admissions to the NICU of a tertiary medical center born ≤ 32 weeks gestation during a 6-month period. Daily progress notes, radiograph reports, and nursing logs were reviewed to identify onset and duration of gaseous distension for each day of a given respiratory support mode. Events were recorded in cases of provider documentation and/or increase in abdominal circumference by 2cm in 24 hours without other identifiable cause. Changes in nutrition, respiratory management or radiographs attributed to gaseous abdominal distension were recorded. Data review stopped when patients reached 2.5kg or were discharged. Data was excluded from subjects with major congenital abnormalities, after abdominal surgery, or during treatment for confirmed Necrotizing Enterocolitis. Event frequencies per use period were compared using Kruskal Wallis test with post-hoc Dunn pairwise comparisons (alpha= 0.05).

Results: 2346 patient days for 41 subjects (mean gestational age= 29 weeks, mean birthweight= 1188g) were analyzed. The mean prevalence of gaseous distension for a day of typical NIV use (29.8%) was ~70% greater than a day of IMV or MS (IMV= 17.7%, p= .0105; MS= 17.6%, p= 0.0478; Figure 1). Gaseous distension was attributed to changes in nutrition or ventilatory support on 7.91% of NIV days (IMV= 4.44%, p= 0.499; MS= 1.83%, p= 0.103; Figure 2).

Conclusion(s): NIV is associated with increased prevalence of gaseous distension and increased interruption of patient nutrition. Further studies are needed to continue to evaluate the impact of NIV on other aspects of non-respiratory care for preterm neonates.