From the Guidelines
Babies may experience oxygen desaturation (de-satting) after feeding due to several physiological factors, and the most effective way to prevent this is by keeping them upright for 20-30 minutes after feeding, as recommended by the American Academy of Pediatrics 1.
Physiological Factors Contributing to Desaturation
The most common reasons for desaturation after feeding include:
- Newborns and young infants being obligate nasal breathers who haven't fully developed coordination between sucking, swallowing, and breathing
- Reflux, as stomach contents backing up into the esophagus can trigger laryngospasm or aspiration, leading to desaturation
- Premature babies being particularly vulnerable due to their immature respiratory systems and weaker muscle tone
Prevention and Management
To prevent desaturation episodes, the following measures can be taken:
- Positioning during and after feeding is crucial - keeping the baby upright for 20-30 minutes after feeding can help prevent reflux and desaturation episodes
- Avoiding overfeeding, frequent burping during feeding, and avoidance of secondhand smoke
- Thickening feedings with commercially thickened formula for infants without milk-protein intolerance does not alter esophageal acid exposure but has been shown to decrease the frequency of regurgitation
- Holding the infant on the caregiver’s shoulders for 10 to 20 minutes to allow for adequate burping after a feeding before placing the infant in the “back to sleep position” can decrease the frequency of GER in infants
Importance of Medical Evaluation
If a baby consistently desaturates after feeding, parents should consult a healthcare provider, as it could indicate more serious conditions like laryngomalacia, tracheomalacia, or cardiac issues that require medical intervention, as suggested by the American Academy of Pediatrics 1. These episodes typically resolve as the baby's respiratory and digestive systems mature, but persistent or severe desaturation warrants medical evaluation. According to the study published in Pediatrics 1, supplemental oxygen is indicated if oxyhemoglobin saturation (SpO2) falls persistently below 90% in previously healthy infants.
From the Research
Desaturation Events in Infants After Feeding
- Desaturation events in infants after feeding have been observed in several studies 2, 3, 4, 5.
- A study published in 1995 found that most infants experienced significantly lower oxygen saturations after feeding than during feeding, with 18% and 29% of postfeed readings being less than 90% in breast-fed and bottle-fed infants, respectively 2.
- Another study published in 2003 found that preterm infants averaged 10.8 desaturation events during feeding, with 59% of these events being classified as mild, 20% as moderate, and 21% as severe 3.
- The presence of a nasogastric tube has been found to increase the duration of desaturation events in very low birth weight infants 4.
- However, a study published in 2009 found that the rates of apnea, bradycardia, and desaturations were not altered by infant feeding in preterm infants 5.
Factors Contributing to Desaturation Events
- Receiving supplemental oxygen and beginning the feeding with a higher baseline oxygen saturation have been found to predict lower percentage of feeding time with oxygen saturation below 90% and fewer desaturation events during feeding 3.
- The presence of a nasogastric tube and a longer transition period from tube feedings to oral feedings have been found to increase the risk of desaturation events in very low birth weight infants 4.
- Breathing pauses, changes in heart rate, and increases in end-tidal CO2 have been found to occur with desaturation events in infants 4.
Monitoring and Prevention of Desaturation Events
- Oxygen saturation needs to be monitored during feedings, and feedings may need to be started with a baseline lowest saturation of 95% or higher 4.
- Monitoring of breathing and heart rate may help prevent desaturation events in infants 4.
- Further research is needed to understand the effects of hypoxemia on the development of oral feeding skills in preterm infants and to develop interventions to minimize desaturation during feeding 3.