Practical review of non-invasive ventilation and feeding intolerance in preterm infants

Patryk Kwapień; Christer Sinderby; Jennifer Beck; Mark Johnson; Tomasz Szczapa

doi:10.20883/medical.e1508

Authors

Patryk Kwapień Poznan University of Medical Sciences
Christer Sinderby Toronto Metropolitan University , St. Michael's Hospital
Jennifer Beck Toronto Metropolitan University , St. Michael's Hospital
Mark Johnson NIHR Southampton Biomedical Research Centre , University of Southampton , University Hospital Southampton NHS Foundation Trust
Tomasz Szczapa Poznan University of Medical Sciences

DOI:

https://doi.org/10.20883/medical.e1508

Keywords:

respiratory support, feeding intolerance, NIV-NAVA, NIPPV

Abstract

Background. Preterm infants in neonatal intensive care units (NICUs) frequently require respiratory and nutritional support. Non-invasive ventilation (NIV)—including nasal continuous positive airway pressure (nCPAP), non-invasive positive pressure ventilation (NIPPV), and humidified high-flow nasal cannula (HHFNC)—has become the preferred respiratory strategy to reduce chronic lung disease and neurological complications. However, these modes may influence feeding intolerance (FI), a multifactorial condition that affects growth and overall clinical outcomes.

Aim. To review current evidence on the relationship between different modes of NIV and feeding intolerance in preterm infants.

Material and methods. A descriptive review of the literature was conducted to evaluate studies on the physiological mechanisms, definitions, and clinical manifestations of FI across various NIV modalities.

Results. Definitions of FI vary considerably among studies. CPAP and NIPPV, particularly non-synchronised modes, are associated with increased abdominal distension and delayed enteral feeding due to gastric insufflation and impaired swallowing coordination. HHFNC demonstrates comparable FI rates but greater infant comfort. NIV-NAVA, a synchronised NIV mode driven by diaphragmatic electrical activity, may reduce gastric insufflation, enhance patient comfort, and improve feeding tolerance, although current evidence is limited. Additional interventions such as oral-motor therapy, sensory stimulation, enteral massage, and skin-to-skin care (SSC) have shown benefits in promoting earlier transition to breastfeeding, improving gastrointestinal function, and enhancing physiological stability, thereby supporting integrated strategies to optimise feeding tolerance in preterm infants.

Conclusions. Ventilatory pressures, synchronisation, and gastrointestinal immaturity influence feeding intolerance in preterm infants. Combining synchronised NIV modes with evidence-based interventions such as SSC and oral-motor therapy may enhance feeding outcomes and overall developmental progress.

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Author Biographies

Patryk Kwapień, Poznan University of Medical Sciences

II Department of Neonatology.
Christer Sinderby, Toronto Metropolitan University, St. Michael's Hospital

Keenan Research Centre for Biomedical Science of St. Michael’s Hospital; Department of Critical Care, St. Michael's Hospital, Toronto, Canada Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada Member, Institute for Biomedical Engineering and Science Technology (iBEST) at Ryerson University and St-Michael’s Hospital, Toronto, Canada.
Jennifer Beck, Toronto Metropolitan University, St. Michael's Hospital

Keenan Research Centre for Biomedical Science of St. Michael’s Hospital; Department of Critical Care, St. Michael's Hospital, Toronto, Canada. Department of Pediatrics, University of Toronto, Toronto, Canada. Institute of Medical Science, University of Toronto, Toronto, Canada Member, Institute for Biomedical Engineering and Science Technology (iBEST) at Ryerson University and St-Michael’s Hospital, Toronto, Canada.
Mark Johnson, NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust

Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
Tomasz Szczapa, Poznan University of Medical Sciences

II Department of Neonatology Poznan University of Medical Science.

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