Share this article on:

Feeding Immaturity in Preterm Neonates: Risk Factors for Oropharyngeal Aspiration and Timing of Maturation

Davis, Natalie L.*; Liu, Ann; Rhein, Lawrence

Journal of Pediatric Gastroenterology and Nutrition: December 2013 - Volume 57 - Issue 6 - p 735–740
doi: 10.1097/MPG.0b013e3182a9392d
Original Articles: Hepatology and Nutrition

Objective: Oropharyngeal aspiration (OPA) is a common cause of morbidity in premature neonates. We sought to identify significant risk factors and determine the timing of feeding maturation in preterm infants with OPA.

Methods: We performed a retrospective medical record review of 148 former preterm neonates referred for modified barium swallow study (MBSS) during a 3-year period. We looked at the MBSS results and potential clinical and demographic risk factors and performed bivariate and multivariable logistic regression analyses to evaluate predictors of failure. We evaluated the timing of resolution of OPA based on MBSS results.

Results: Of the 148 infants comprising our study cohort, 47 (32%) passed their initial MBSS and 101 (68%) were found to aspirate thin liquids. Infants who aspirate had younger corrected gestational age (CGA) and postnatal age at the time of testing. Increasing CGA led to lower odds of failing. Infants passed a MBSS at a median CGA of 53 weeks and those who failed an initial MBSS eventually passed after a median of ∼3.4 months from the first study. Infants with bronchopulmonary dysplasia had lower odds of failing their MBSS (odds ratio 0.16), but those taking inhaled corticosteroids and diuretics had higher odds of failing, and infants who were multiples also had higher odds of failing.

Conclusions: We determined the median CGA for passing MBSS and identified risk factors for OPA in this population. This information can help guide providers when counseling families on timing of feeding maturity and anticipation of appropriate timing for follow-up MBSS testing.

*Division of Neonatology, University of Maryland Hospital for Children, Baltimore, MD

Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA.

Address correspondence and reprint requests to Natalie L. Davis, MD, MMSc, Division of Neonatology, University of Maryland Hospital for Children, 110 S Paca St, 8th Floor, Baltimore, MD 21201 (e-mail:

Received 24 May, 2013

Accepted 8 August, 2013

Dr Davis and Ms Liu are co-first authors.

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,