External abdominal support intervention for preterm infants receiving non-invasive positive pressure support: A case series

Background Non-invasive positive pressure support (NPPS) can contribute to excessive gastrointestinal air accumulation in preterm infants, resulting in gaseous abdominal distension and gastrointestinal (GI) dysmotility. Evidence supporting interventions to manage these effects is limited. This study explored GI and safety outcomes associated with an external abdominal support intervention (ASI) in preterm infants receiving NPPS. Methods This retrospective, pre-post case series included 16 infants receiving ASI while on NPPS between June 2024 and February 2025. GI outcomes included daily frequency of emesis, glycerin administration, and abdominal radiographs obtained for abdominal concerns before and during ASI. Abdominal radiographs were also classified descriptively as Normal, CPAP Belly, or Other. Safety outcomes included necrotizing enterocolitis (NEC) and skin breakdown. Results Following ASI initiation, median daily emesis frequency decreased from 0.42 to 0.08 episodes/day ( p = .04), glycerin administration from 0.02 to 0 administrations/day ( p = .04), and abdominal radiographs obtained for abdominal concerns from 0.06 to 0 radiographs/day ( p = .02). Among infants with available radiographs, a CPAP Belly pattern was present in 10/14 (71.4%) before ASI and 5/12 (41.7%) during ASI. No infants developed NEC during the intervention. One infant experienced transient skin breakdown associated with incorrect device application. The event resolved within 48 hours, and ASI was subsequently resumed. Conclusion External abdominal support was feasible to implement in this small cohort of preterm infants receiving NPPS. Lower frequencies of emesis, glycerin administration, and abdominal radiographs for abdominal concerns were observed during ASI use. Prospective controlled studies are needed to evaluate the safety and effectiveness of external abdominal support.