Oropharyngeal Immunotherapy (OPI) Protocol for Preterm Infants
Oropharyngeal Immunotherapy (OPI) Protocol
Introduction
Oropharyngeal immunotherapy (OPI) involves applying colostrum or mother’s own milk (MOM) directly to the oral mucosa. This safe practice modulates immune function and stimulates gastrointestinal development in premature infants when started as soon as possible after birth. It is especially important for ELBW infants and those born before 32 weeks gestational age.
OPI is given to all NPO infants as soon as colostrum/MOM is available. Current evidence supports this practice in neonates who are intubated or NPO due to their clinical condition.
OPI should ideally be initiated on the first day of life and continued until oral feedings are initiated (2 PO feeds per day).
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.
Colostrum will not be frozen and should be administered immediately after expression or within 4 hours after expression.
Never use frozen, fortified breast milk, or donor milk for OPI.
MOM will 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.
5. The contraindications for OPI are the same as for breastfeeding (maternal HIV status positive, human T-cell lymphotropic virus (HTLV), untreated or active tuberculosis, galactosemia, and mothers on contraindicated medications e.g., antiretroviral medications, chemotherapy, or those being exposed or treated with radioactive isotopes).
Important Considerations for OPI
Avoid
- Frozen colostrum/MOM due to 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 decreases their antimicrobial functions.
- OPI using a gauze swab – This will absorb colostrum/MOM, leaving little to be absorbed by the infant.
- OPI using a gloved finger – This inhibits the ability to accurately measure MOM and could create a negative oral experience for the infant.
OPI Procedure
Dose: 0.2 mL given with a sterile oral syringe
Administration: 0.1 ml of colostrum/MOM slowly over 5-10 seconds to each oral buccal mucosa.
Frequency of treatment: Every three hours. Liaise with maternity services to provide prompts to express when mothers are not clinically stable enough to visit the unit.
Directions for OPI Administration
- Gently insert the tip of the oral syringe into the infant’s mouth along the right side and direct the syringe tip posteriorly toward the oropharynx and slowly give 0.1 mL over at least 5-10 seconds.
- Repeat the procedure on the other side but without removing the syringe from within the infant mouth.
- There is no need to turn the baby during this procedure.
- Avoid oral suction for 30 minutes. Suction excess secretions from the mouth and oropharynx with an oral suction device only if needed.
- If enteral feeds are initiated, the OPI should be given first and then the OG/NG feed.
- Monitor the infant for any physiologic instability during the application of OPI.
- After appropriate education, parents should be encouraged to participate in OPI.
- OPI should be performed at each care time as ordered, unless the infant has successfully latched.
Duration of therapy: Continue OPI until initiation of oral feedings, at least twice per day (~32 weeks CGA).
Review the safe provision of OPI.