In this section
Sham feeding is used to enable the infant to learn to feed orally either by breast or bottle prior to repair of the oesophageal atresia.A sham feed is a feed given to an infant with unrepaired long-gap oesophageal atresia, with a Replogle Tube connected to suction, which drains the milk from the upper oesophageal pouch to prevent aspiration. The feed is removed from the oesophageal pouch by suction and re-fed to the infant via the gastrostomy tube to enable oral feeding to be associated with milk entering the stomach at the same time.
To enable infants with unrepaired long-gap oesophageal atresia to learn to feed orally.
Oesophageal atresia (OA): A congenital anomaly in which the oesophagus ends in a blind upper pouch. Most neonates with OA also have an abnormal connection between the trachea and oesophagus; this is called a tracheo-oesophageal fistula (TOF).
Long-gap oesophageal atresia: Infants with:
Infants with long-gap OA are often managed with a delayed oesophageal repair, a growth induction procedure or oesophageal replacement surgery.
Replogle tube: A double lumen tube which is placed into the oesophageal pouch and connected to continuous low pressure suction (-15 to -35 cmH20), allowing the pouch to be kept clear of saliva and secretions which can spill into the lungs.Foker Procedure: Involves growth induction of the oesophagus. The Foker process uses tension-induced growth to enable primary oesophageal reconstruction in patients with long gap oesophageal atresia. Sutures are placed on the upper and lower ends of the oesophagus and brought out onto the neonate's chest wall. Tension is applied to the sutures by placing short pieces of silastic tubing under the suture loops, with the tension usually increased each day over a 1-3 week period. When enough growth in the oesophageal ends has been achieved, the infant returns to theatre for an oesophageal atresia repair (oesophageal anastomosis). The Foker procedure may also include the placement of internal sutures on the upper and lower oesophageal segments. Growth induction procedures: Other growth induction procedures may also be undertaken, involving internal sutures on the oesophageal ends, prior to full repair of the OA.
Assessment of suitability of infant for sham feeding:
Ongoing assessment of cardio-respiratory status during and post sham feed with observation for respiratory compromise including:
Assessment of feeding including:
If the infant has any signs of respiratory distress/compromise or difficulty with the sham feed, or coughing or choking episodes, the sham feed should be ceased immediately. The infant should be reassessed by the Oesophageal Atresia Nurse for safety regarding sham feeding before another sham feed is attempted by bedside nursing staff.If there is any pink or blood stained aspirate, cease the sham feed immediately and check the suction pressure is not higher than -50mmHg. Contact the neonatal and surgical teams (and the Oesophageal Atresia Nurse if available), and withhold sham feeds until consent is given by the surgical team to continue with sham feeds. Document any problems with sham feeding in the EMR (Progress Notes).
It is the responsibility of the clinician caring for the infant receiving sham feeding to ensure that the parents understand the rationale for the intervention, as well as potential complications.
Sham feeding for infants with unrepaired long-gap oesophageal atresia Evidence Table
Please remember to read the disclaimer
development of this nursing guideline was coordinated by Alisa Hawley, RN, Butterfly Ward and Sharlene Pattie,Clinical Nurse Educator, Butterfly Ward,
and approved by the Nursing Clinical Effectiveness Committee. Updated July 2016.