Neonatal feeding performance is related to feeding outcomes in childhood

Exploration of the Association Between Sucking Measures and Ability to Attain Independent Oral Feeds Among Infants Who Are Born Preterm

IMPORTANCE

Infants who are born preterm often experience difficulty transitioning from full tube to independent oral feeds, which often prolongs their hospital stay. No clinical measures associated with attainment of independent oral feeds are currently available.

OBJECTIVE

To identify specific nutritive sucking measures associated with time to attainment of independent oral feeds among infants who are born preterm.

DESIGN

An observational cohort pilot study was undertaken.

SETTING

A Level 2 to Level 3 neonatal intensive care unit.

PARTICIPANTS

Fourteen infants (7 male, 7 female) born at or less than 34 wk gestation were enrolled.

OUTCOMES AND MEASURES

The monitored suck measures included average suck strength (millimeters of mercury), average sucking burst duration (seconds), average suck count (number of sucks), and average pause duration (seconds). Time to independent oral feeds (days) and baseline characteristics were also monitored. The nutritive sucking measures were recorded once, during the first 5 min of an oral feed, when infants were taking an average of three to four oral feeds per day using a nipple monitoring device.

RESULTS

An inverse relation was found among average suck burst duration (p = .04), gestational age (p = .03), and days to attainment of independent oral feeds.

CONCLUSIONS AND RELEVANCE

Study results suggest that average sucking burst duration, during the first 5 min of an oral feed, is associated with time to attain independent oral feeds. Plain-Language Summary: Sucking burst duration is a simple measure that may be used clinically to identify early on infants who may have trouble transitioning from full tube to independent oral feedings. The results of this study suggest that a suck burst duration in the first 5 min of an oral feeding is inversely associated with the length of time to achieve independent oral feeding. The results highlight the importance of considering an infant's nutritive sucking ability when evaluating their potential to achieve independent oral feedings.

Relationships between preterm medical factors and feeding behaviors at term-equivalent age

AIM

To identify relationships between early medical factors and preterm infant feeding behaviors at term-equivalent age.

METHODS

Forty-three very preterm infants born ≤32 weeks gestation had standardized feeding assessments using the Neonatal Eating Outcome Assessment at term-equivalent age (36-42 weeks postmenstrual age). Medical factors were collected and analyses were run to determine if associations between different medical factors and feeding performance exist.

RESULTS

Lower Neonatal Eating Outcome Assessment scores at term-equivalent age were associated with lower estimated gestational age (p < .01), lower birthweight (p < .01), older postmenstrual age at discharge (p < .01), longer length of stay in the neonatal intensive care unit (p < .01), chronic lung disease (p = .03), as well as more days on total parenteral nutrition (p = .03), endotracheal intubation (p < .01), and noninvasive mechanical ventilation (p < .01).

CONCLUSION

More feeding problems are observed in infants born earlier, with longer hospital stays, and with complex medical courses. Knowledge of the association between these medical factors and feeding difficulties allows for identification of infants who may benefit from early, targeted interventions to optimize the feeding process.

Item-Level Psychometrics of the Neonatal Eating Outcome Assessment in Orally Feeding Infants

BACKGROUND

The Neonatal Eating Outcome Assessment determines feeding performance based on the infant's postmenstrual age (PMA).

OBJECTIVE

To examine item-level measurement properties of this assessment's rating scale.

METHODOLOGY

In this retrospective study, Rasch analysis was completed on clinical data from the Neonatal Eating Outcome Assessment for 100 infants (52 preterm and 48 full-term) using Winsteps version 3.93.1. Instead of PMA-based scores, ordered letters converted to numerical scores were analyzed.

RESULTS

Analysis demonstrated that Section I (Pre-Feeding Skills) represents a separate construct from Sections II and III (Oral Feeding and End of Feeding, respectively). Sections II and III were adequately unidimensional to complete Rasch analysis. These sections fit the Rasch model overall, but rating scale category underuse was common, which may be attributed to sample characteristics.

IMPLICATIONS

This analysis supports using validated ordered letter scoring of Sections II and III to measure oral feeding performance in preterm and full-term newborns.

A Unique Clinical Tool for the Evaluation of Oral Feeding Skills in Infants

Background. Occupational therapy practice for oral feeding assessment is based on clinical observation of infants' sucking, swallowing, and breathing ability, which is influenced by clinical experience and provides poor evidence on explanatory factors. Purpose. To test the clinical utility and safety of a nipple monitoring device for the quantitative evaluation of oral feeding skills. Method. Sixteen infants, with no severe medical complications, participated in a pre-experimental pilot study. Oral feeding performances (duration, intake volume, and rate of transfer), and occurrence of adverse events (apnea, bradycardia, and oxygen desaturations) were recorded to ensure the tool does not interfere with infant's feeding ability or does not create any adverse effects. Findings. There was no significant difference in duration, intake volume, rate of transfer between the two monitored sessions, and no occurrence in adverse events. Implications. The findings suggest that the nipple monitoring device may be used for quantitative assessment and intervention planning of oral feeding difficulties in infants.

[Feeding and growth patterns in preterm children at 3-4 years of age]

AIM

to describe the feeding and growth patterns of preterm-born children at preschool age, considering feeding problems based on behaviours and skills, diet quality and parental feeding practices.

METHODS

a cross-sectional study was performed on preterm children born in Asturias (Spain) in 2016 (n = 94). When preterm-born children reached 3-4 years of age their families were asked to complete the Behavioral Pediatrics Feeding Assessment Scale and a food frequency questionnaire to identify possible feeding problems and assess diet quality (KIDMED index), respectively. Self-reported anthropometric data were also collected to assess weight growth. Electronic health records were reviewed to gather gestational and neonatal clinical data.

RESULTS

feeding problems were found in 7.4 % of children and 20.2 % of parents. According to the KIDMED index, 25.5 % of children had a high-quality diet. Feeding problems were higher in children born before 32 weeks of gestation, and decreased in frequency as the gestational age increased (p = 0.030). No differences were found in parental feeding practices (p = 0.455) or diet quality according to gestational age (p = 0.399), but body weight at 3-4 years was lower in preterm-born children (p = 0.015).

CONCLUSIONS

feeding patterns of preterm-born children were suitable at the age of 3-4 years, but diet quality was moderate to poor in the majority of children. Follow-up of very preterm children beyond 3-4 years of age becomes necessary as they displayed more feeding problems and lower body weight.

Investigation of the relationship between feeding problems and cognitive functions in premature children

Children with a history of premature birth may show various problems in feeding, and these problems may continue at school age. It is necessary to examine the role of cognitive functions in children's feeding with more detailed studies.Comparison of feeding problems and cognitive functions of premature and full-term children and examining the relationship between them. The parents of 60 children aged 6-10 completed the The Screening Tool of Feeding Problems, and the cognitive functions of the children were evaluated with the Dynamic Occupational Therapy Cognitive Assessment. Results are compared and correlations betweeen feeding problems and cognitive functions were examıned. Feeding problems of premature children are statistically higher than those born at term; their cognitive functions were statistically weaker (p < 0.001). It was found that feeding problems and cognitive functions were statistically related in premature children (p < 0.05). Feeding problems seen in premature children may be related to their weaker cognitive functions compared to their peers. It is important to evaluate cognitive functions and include them in the intervention in rehabilitation programs to be prepared for premature children with feeding problems.