Oropharyngeal Immunotherapy (OPI): Protocol and Benefits

Posted on Mar 17, 2025 in Other university degrees and diplomas

Oropharyngeal Immunotherapy (OPI)

Introduction: Oropharyngeal Immunotherapy (OPI) involves applying colostrum or mother’s own milk (MOM) directly onto the oral mucosa. OPI requires a specific dose and frequency.

  1. OPI is given to ALL NPO infants as soon as colostrum/MOM is available. Current evidence supports this practice in neonates who are NPO, intubated, and/or receiving enteral nutrition.
  2. OPI should be initiated on the first day of life and continued until oral feeds are introduced.
  3. Protective breastfeeding (PBF) should be used as an alternative for OPI.
  4. Only the mother’s own colostrum/MOM should be used for OPI.
  5. If needed, prioritize MOM for OPI and donor milk for enteral feedings. Donor milk is not suitable for OPI.

Colostrum should not be frozen and should be administered immediately or within 4 hours after expression.

MOM should be stored in the refrigerator for 48-72 hours (per breast milk storage guidelines). Stored colostrum/MOM should be used in order of expression if fresh colostrum/MOM is unavailable.

Contraindications

The same contraindications apply as for breastfeeding: Maternal HIV-positive status, HTLV, untreated or active tuberculosis, galactosemia, and mothers on contraindicated medications (antiretroviral medications, chemotherapy, and/or exposed to radiation). Viral illnesses such as chickenpox, hepatitis B and C, HSV, and CMV are also contraindications.

What to Avoid

  • Frozen colostrum/MOM: There is a degradation of the bioactive compounds essential to the immune process.
  • Fortified MOM: The iron-enriched fortifier in the milk may limit the immune benefits of the OPI.
  • Donor milk: The pasteurization process destroys human milk immune biofactors or significantly decreases their antimicrobial functions.
  • OPI using a gauze swab: It will absorb colostrum/MOM, leaving little to be absorbed by the infant.
  • OPI using a gloved finger: It inhibits the ability to accurately measure MOM and could create a negative oral experience for the neonate.

Procedure

(Review the safe provision for OPI)

Dose: 0.2 mL given with a 1 ml sterile oral syringe.

Administration: 0.1 ml of colostrum/MOM slowly over 5-10 seconds to each oral buccal mucosa.

Frequency: Every three hours. Continue OPI until the neonate can take two PO feeds per day.

Directions

  1. Gently insert the tip of the oral syringe into the infant’s mouth along the right side and direct the tip of the syringe posteriorly toward the oropharynx, slowly giving 0.1 mL over at least 5-10 seconds.
  2. Repeat the procedure on the other side but without removing the syringe from within the infant’s mouth.
  3. There is no need to turn the baby during this procedure.
  4. Avoid oral suction for 30 minutes. If needed, you may suction excess secretions from the mouth and oropharynx with an oral suction device before the OPI is given.
  5. If enteral feeds are initiated, the OPI should be given first, then start the gavage feed after it.
  6. Monitor the infant for any physiologic instability during the OPI application. Report and record any adverse events.
  7. After appropriate education, parents should be encouraged to participate in OPI.
  8. OPI should be performed with clustered care as ordered, unless the infant has successfully latched.