Abdominal Binders to Minimize Enteral Nutrition Disruptions for Preterm Infants On Non-Invasive Respiratory Support

Background Preterm neonates who require respiratory support benefit from the use of non-invasive respiratory support over invasive mechanical ventilation to decrease rates of chronic lung disease [1]. Non-invasive support typically involves positive end-expiratory pressure which allows for distending pressures to keep the alveoli of the lungs open [1]. In our institution, this typically includes continuous positive airway pressure (CPAP) or non-invasive mechanical ventilation (NIMV). Mechanistically, due to the positioning of the trachea adjacent to the esophagus, the provision of pressure support for the lungs often results in additional air and pressure being supplied to the enteric tract. This can result in what is called "CPAP belly" [2]. Although CPAP belly was initially described as a benign gaseous distension, emerging evidence shows it has negative impacts on the functionality of the enteric tract, including delaying gastric emptying time [2,3]. A recent study characterizing CPAP belly has shown that it can lead to longer time to full enteral feeds, disruptions to feeding practices, and additional abdominal radiography [4].

Several strategies have been tried to decrease feeding intolerance in infants with abdominal distension, including early enteral feeds, which is our current practice, abdominal massages, and probiotic therapy [5,6]. Recently, a novel idea was proposed to combat the progression of CPAP belly: abdominal binding to support the abdominal wall musculature [7]. It was initially reported as a case study of two infants with significant abdominal distension while on respiratory support who had improvements in their distension back to expected range within one week of therapy initiation and without any reported adverse effects [7]. The author of this article has created a product, the NeoBellyBand for sale by the DandleLION Medical company, for use in her own institution. It is now in use in several institutions, given its minimal risk to patients and the potential benefits, as the new standard of care. In speaking with the developer of this product, we understand that there are also ongoing pre-and post-intervention studies looking at its impact on decreasing rates of chronic lung disease or length of stay in the NICU.

There is little published evidence for or against the use of abdominal binding in this population and there are no current studies that the research team is aware of looking at its impact on feeding practices in the NICU. Prior to the use of abdominal binding, we would like to study its safety and efficacy for the neonatal population. We hypothesize that the use of abdominal binders will lead to a decrease in feeding interruption events as well as a decrease in adverse feeding and respiratory outcomes for preterm neonates on non-invasive respiratory support.

The specific aims of this study are to:

1. Evaluate the impact of abdominal binders on decreasing interruptions to our unit feeding protocol due to feeding intolerance symptoms, such as increased abdominal distension or high-volume gastric residuals, compared with our current standard of care.
2. Analyze the effect of abdominal binding on time to major neonatal milestones, including discontinuation of respiratory support, discontinuation of parenteral nutrition, full oral feeds, discontinuation of therapies to promote regular stooling (such as glycerin suppositories or prune juice), and discharge from hospital.
3. Determine how the use of abdominal binders changes respiratory management (such as increasing respiratory pressures for worsening distension) and respiratory outcomes (such as chronic lung disease).
4. Evaluate the safety of abdominal binders by tracking possible adverse effects, including temperature regulation concerns, skin integrity concerns, and incidence and complications associated with umbilical or inguinal hernias.