In a premature infant with a resting respiratory rate of 60 breaths per minute, increasing to more than 90 breaths during feeding, what is the next step?

• A. Stop oral feeding immediately
• B. Continue oral feeding but provide more breaks
• C. Stop feeding until respiratory rate returns to normal and then continue
• D. Suggest nonnutritive sucking on a pacifier and continue oral feedings with frequent breaks

Answer: (A)

Recognizing signs of respiratory distress during feeding is crucial in premature infants because their coordination of sucking, swallowing, and breathing is still immature. A resting rate around 60 breaths per minute is already elevated for a preterm infant, and a rise to more than 90 during feeding indicates the infant is working too hard to breathe and may not be able to protect the airway. The safest next step is to stop oral feeding immediately. This prevents potential aspiration and allows the clinical team to reassess the infant’s breathing, oxygenation, and overall stability before considering any further feeding. After the infant stabilizes, feeding can be resumed with careful monitoring and, if needed, alternative approaches such as nonoral nutrition or paced, closely watched feeds. Continuing feeding with breaks or using nonnutritive sucking does not address the underlying distress and could increase risk, so they aren’t appropriate in this situation.