Oral Feeding and aspiration risk in children on high flow respiratory support.

Respiratory illness is the most common reason for young children to be hospitalised. Many children receive High Flow Nasal Cannula (HFNC) respiratory support which delivers high flow rates of heated humidified air/oxygen to the nose through nasal prongs to assist their breathing. However, it is currently unknown whether it is safe for children to eat and drink whilst they are receiving HFNC support. HFNC increases pharyngeal pressures to keep the airway open and reduce work of breathing, but it is suspected that these increased pressures may affect a child’s ability to protect their airway during swallowing. This may cause food or fluid into enter the child’s lungs when eating or drinking (oropharyngeal aspiration) when on HFNC, and this may damage the lungs and prolong the child’s recovery. This study aims to determine whether oropharyngeal aspiration occurs (incidence of aspiration) by having a speech pathologist assess the child’s feeding and swallowing at the bedside (and listening to swallow sounds via a microphone attached to the throat) and whist eating and drinking during a videofluoroscopic swallow study (VFSS, a dynamic x-ray procedure). The research speech pathologist will assess 60 children from preterm (35 weeks gestational age) through to 5 years of age who are receiving HFNC respiratory support. We hypothesize that preterm and infant children will have a higher incidence of aspiration than older children; and that children on higher HFNC flow rates will have a higher incidence of aspiration than those on lower flow rates. Our study findings will inform the development of evidence-based guidelines to inform healthcare professionals about the safety for oral feeding of young children receiving HFNC respiratory support.