1
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Ibrahim C, Grabill M, Smith J, Pineda R. Relationships between preterm medical factors and feeding behaviors at term-equivalent age. Early Hum Dev 2024; 191:105975. [PMID: 38492414 PMCID: PMC11019834 DOI: 10.1016/j.earlhumdev.2024.105975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/18/2024]
Abstract
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.
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Affiliation(s)
- Carolyn Ibrahim
- College of Health Sciences, Rush University, Chicago, IL, United States of America
| | - Molly Grabill
- Washington University Program in Occupational Therapy, St. Louis, MO, United States of America
| | - Joan Smith
- Saint Louis Children's Hospital Department of Quality, Safety & Practice Excellence, St. Louis, MO, United States of America
| | - Roberta Pineda
- Washington University Program in Occupational Therapy, St. Louis, MO, United States of America; Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America.
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2
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Capra ME, Decarolis NM, Monopoli D, Laudisio SR, Giudice A, Stanyevic B, Esposito S, Biasucci G. Complementary Feeding: Tradition, Innovation and Pitfalls. Nutrients 2024; 16:737. [PMID: 38474864 DOI: 10.3390/nu16050737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
According to WHO, "complementary feeding (CF) is the process starting when breast milk alone or infant formula alone is no longer sufficient to meet the nutritional requirements of infants, and therefore, other foods and liquids are needed, along with breast human milk or a breastmilk substitute". CF is one of the most important "critical and sensitive periods" in human life: indeed, timing and approaches to solid foods introduction in an infant's nutrition are of utmost importance as potential epigenetic factors from infancy to adulthood. CF is also deeply influenced by each country and single-family traditions, culture, and beliefs. The aim of our narrative review is to analyze traditional CF practices, including innovative and alternative ones that emerged in the last decades, such as baby-led weaning or plant-based weaning, and to evaluate their effects on the risk of developing non-communicable diseases. Moreover, we will discuss pitfalls and misunderstandings that pediatricians frequently have to face when dealing with complementary feeding. Health care professionals must not have prejudices against parents' wishes or traditions about CF; rather, they should support and educate them in case of any alternative CF choice, always pursuing the infant's adequate growth, neuro- and taste development, and the achievement of correct eating behavior as the primary goal.
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Affiliation(s)
- Maria Elena Capra
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
- Italian Society of Pediatric Nutrition (SINUPE), 20126 Milan, Italy
| | - Nicola Mattia Decarolis
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Delia Monopoli
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Serena Rosa Laudisio
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Antonella Giudice
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Brigida Stanyevic
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
- Italian Society of Pediatric Nutrition (SINUPE), 20126 Milan, Italy
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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3
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Verma RP, Sahni D, Fogel J. Bolus Feeding Via Gastric Versus Oral Routes in Very Preterm Neonates. JOURNAL OF MOTHER AND CHILD 2024; 28:1-7. [PMID: 38411990 PMCID: PMC10898621 DOI: 10.34763/jmotherandchild.20242801.d-23-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/01/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND We intend to investigate the association of bolus orogastric tube (BOG) and nipple bottle (N) feedings with postnatal growth in very premature neonates (VPN: gestational age between 28 and 33 weeks). MATERIAL AND METHODS The days of life (DOL) to achieve full combined oral and gastric enteral nutrition (FEN) and attain body weight (BW) of 2200 g (Wt22) and the length of hospitalization (LOH) were retrospectively associated with clinical and BOG and N feeding-related variables via multivariate regression analyses. Correlations were performed to ascertain the strength of associations. RESULTS In a cohort of 127 VPN, FEN demonstrated negative associations with gestational age (GA) and LOH and Wt22 with birth weight (BW). FEN showed positive associations with nil by mouth and intravenous fluid-nutrition days and with DOL to start and achieve full nipple feeding. LOH was associated with days on antibiotics and DOL to start and achieve full nipple feeding. Wt22 was associated with DOL to achieve full nipple feeding. The start day of BOG feeding had no independent associations and weak, highly significant positive correlations with Wt22, LOH, and FEN. CONCLUSION Bolus orogastric tube feeding has no independent implications for postnatal growth, duration of hospitalization, or chronological age to attain full enteral nutrition in VPN unless combined with nipple feeding to provide enteral nutrition. Oral bottle feeding accelerates postnatal catch-up growth and full enteral nutrition acquisition while reducing hospitalization duration. Initiating nipple feeding at 32 weeks of postmenstrual age may be safe in stable VPN. Antibiotic therapy increases hospitalization duration.
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Affiliation(s)
- Rita P. Verma
- Nassau University Medical Center, East Meadow, NY11554, NYC Health+ Hospitals/South Brooklyn Hospital, Coney Island, NY11235
| | - Deepank Sahni
- Nassau University Medical Center, East Meadow, New York, 11554
| | - Joshua Fogel
- Nassau University Medical Center, New York, NY 11210
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4
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Pham A, Ezzeddine L, Bonnard A, Lapillonne A, Rousseau V, Montalva L, Khattat N, Guilbert J, Mokhtari M, Fouquet V, Jaby O, Decobert F, Mitanchez D, Ducou Le Pointe H, Irtan S. Usefulness of routine early œsophagogram after primary repair of œsophageal atresia: a multicenter study. Pediatr Res 2023; 94:1779-1783. [PMID: 37328687 DOI: 10.1038/s41390-023-02696-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Advances in surgical and neonatal care have led to improved survival of patients with œsophageal atresia (OA) over time. Morbidity remains significant, with one-third of patients being affected by a postoperative complication. Several aspects of management are not consensual, such as the use of œsophagogram before starting oral feeding. METHODS We conducted a multicenter retrospective study, including all children with OA that underwent a primary anastomosis in the first days of life, between 2012 and 2018 in five French centers, to determine the usefulness of postoperative œsophagogram during the 10 days after early primary repair of OA to diagnose the anastomotic leak and congenital œsophageal stenosis. RESULTS Among 225 included children, 90 (40%) had a routine œsophagogram and 25 (11%) had an anastomotic leak, clinically diagnosed before the scheduled œsophagogram in 24/25 (96%) children at median postoperative day 4. Ten patients had associated congenital œsophageal stenosis diagnosed on the œsophagogram in only 30% of cases. CONCLUSION Early œsophagogram is rarely useful in the diagnosis of an anastomotic leak, which is clinically diagnosed before performing an œsophagogram in the majority of cases. The need for a postoperative œsophagogram should be evaluated on a case-by-case basis. IMPACT Early œsophagogram is not helpful in the diagnosis of an anastomotic leak in the majority of cases. An anastomotic leak is most often diagnosed clinically before performing an œsophagogram. Early postoperative œsophagogram could be helpful for the diagnosis of congenital œsophageal stenosis. However, dysphagia occurs later and early diagnosis of congenital œsophageal stenosis has no impact on the management and outcome of asymptomatic children. Indication of postoperative œsophagogram has to be evaluated on a case-by-case basis.
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Affiliation(s)
- Aurélie Pham
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of Neonatal Medicine, 75012, Paris, France.
| | - Lynn Ezzeddine
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of Pediatric Radiology, 75012, Paris, France
| | - Arnaud Bonnard
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Robert-Debré University Hospital, Department of Pediatric General Surgery and Urology, 75019, Paris, France
| | - Alexandre Lapillonne
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Necker-Enfants Malades University Hospital, Neonatal Intensive Care Unit, 75015, Paris, France
| | - Véronique Rousseau
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Necker-Enfants Malades University Hospital, Department of Pediatric Surgery, 75015, Paris, France
| | - Louise Montalva
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Robert-Debré University Hospital, Department of Pediatric General Surgery and Urology, 75019, Paris, France
| | - Nizar Khattat
- Paris-Cité University, Assistance publique des hôpitaux de Paris, Robert-Debré University Hospital, Neonatal Intensive care unit, 75019, Paris, France
| | - Julia Guilbert
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Intensive neonatal and pediatric care unit, 75012, Paris, France
| | - Mostafa Mokhtari
- Paris Saclay University, Assistance publique des hôpitaux de Paris, Kremlin Bicêtre Hospital, Neonatal Intensive care unit, 94250, Le Kremlin Bicêtre, France
| | - Virginie Fouquet
- Paris Saclay University, Assistance publique des hôpitaux de Paris, Kremlin Bicêtre Hospital, Department of Pediatric Surgery, 94250, Le Kremlin Bicêtre, France
| | - Olivier Jaby
- Centre hospitalier intercommunal de Créteil, Department of Pediatric Surgery, 94300, Créteil, France
| | - Fabrice Decobert
- Centre hospitalier intercommunal de Créteil, Neonatal Intensive Care Unit, 94300, Créteil, France
| | - Delphine Mitanchez
- François Rabelais University, CHRU de Tours, Bretonneau Hospital, Neonatal Intensive Care Unit, 37000, Tours, France
| | - Hubert Ducou Le Pointe
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of Pediatric Radiology, 75012, Paris, France
| | - Sabine Irtan
- Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of visceral and neonatal pediatric surgery, 75012, Paris, France
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5
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Sheikh-Mohamed SO, Wilson H, Fucile S. Interventions to Enhance Achievement to Independent Oral Feeds in Premature Infants: A Scoping Review. Phys Occup Ther Pediatr 2023; 44:295-315. [PMID: 37867325 DOI: 10.1080/01942638.2023.2271064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
AIM To assess the effectiveness of interventions aimed at facilitating the transition from full tube to independent oral feeds in premature infants. METHODS Scoping review methodology using the Preferred Reporting items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA_ScR). A search of six databases (EMBASE, MEDLINE, CINAHL, Web of Science, COCHRANE, and OT Seeker), using keywords related to oral feeding and premature infants retrieved 11,870 articles. Full-text screening was completed for 36 articles, and 21 articles were included in this review. RESULTS Review of the 21 articles revealed five intervention types: oral stimulation (n = 14), swallow/gustatory stimulation (n = 3), olfactory stimulation (n = 2), tactile/kinesthetic stimulation (n = 1), and auditory stimulation (n = 1). Oral stimulation had the most studies with consistent evidence supporting its beneficial effect to facilitate achievement to independent oral feeds, swallow/gustatory stimulation appeared to have some benefit, but evidence for olfactory, tactile/kinesthetic, and auditory stimulation was sparse. CONCLUSION Oral stimulation has the most studies with consistent evidence, and thus is suggested as a suitable early intervention strategy that can be used by health providers to facilitate the achievement to independent oral feeds in premature infants. The alternate forms of stimulation have limited evidence and necessitate further studies to confirm their benefits.
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Affiliation(s)
| | - Hillary Wilson
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Sandra Fucile
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
- Department of Pediatrics, Queen's University, Kingston, Canada
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6
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Fucile S, Dow K. A Unique Clinical Tool for the Evaluation of Oral Feeding Skills in Infants. Can J Occup Ther 2023; 90:240-248. [PMID: 36314405 PMCID: PMC10422857 DOI: 10.1177/00084174221134738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Sandra Fucile
- Sandra Fucile, Watkins 4.4.321, 76 Stuart Street, Kingston, Ontario K7L 2V7.
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7
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Heyward A, Minich N, Hoffman AC, Hibbs AM, Zhao L, Crowley M. Characteristics and outcomes of neonatal opioid withdrawal syndrome in preterm infants: a retrospective cohort study in the current era. J Perinatol 2023; 43:909-915. [PMID: 37188773 DOI: 10.1038/s41372-023-01672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 12/15/2022] [Accepted: 01/05/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Compare Neonatal Opioid Withdrawal Syndrome (NOWS) in preterm and term infants. STUDY DESIGN Single center, retrospective chart review of all in-utero opioid exposed infants born between 2014 and 2019. Withdrawal symptoms were assessed using Modified Finnegan Assessment Tool. RESULTS Thirteen preterm (PT), 72 late preterm (LPT), and 178 term infants were included. Preterm and LPT compared to term infants had lower peak Finnegan scores (9/9 vs. 12) and received less pharmacologic treatment (23.1/44.4 vs. 66.3%). Similar onset, peak symptoms, and treatment duration was observed in LPT and term infants. CONCLUSIONS Preterm and LPT infants have lower Finnegan scores and require less pharmacologic therapy for NOWS. It is unclear if this is because our current assessment tool does not capture their symptoms or if they truly have less withdrawal. Onset of NOWS is similar in LPT and term infant, thus LPT infants do not require prolonged hospital monitoring for NOWS.
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Affiliation(s)
- Alicia Heyward
- Division of Neonatology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Nori Minich
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Adriana C Hoffman
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Anna Maria Hibbs
- Division of Neonatology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lulu Zhao
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Moira Crowley
- Division of Neonatology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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8
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Alm S, Stoltz Sjöström E, Domellöf M. Prevalence and Risk Factors for Post-Discharge Feeding Problems in Children Born Extremely Preterm. J Pediatr Gastroenterol Nutr 2023; 76:498-504. [PMID: 36652562 PMCID: PMC10013140 DOI: 10.1097/mpg.0000000000003704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Preterm infants have a high risk of post-discharge feeding problems, but there is a lack of population-based studies in infants born extremely preterm and little is known about underlying mechanisms. The objectives were to assess the incidence of post-discharge feeding problems and underweight in a population-based cohort of infants born extremely preterm in Sweden (EXPRESS) and identify perinatal risk factors. METHODS Perinatal health data and prenatal/postnatal growth data was prospectively collected in the cohort. Data on clinical diagnoses related to feeding problems were obtained from the Swedish Patient Register and population prevalence data was also obtained. The main outcome was a composite of post-discharge feeding problem diagnosis and/or underweight at 2.5 years of age. RESULTS In total, 66 children (19%) had post-discharge feeding problems diagnosed before 2 years and/or underweight at 2.5 years of age. The risk of feeding problems when compared to the general population was significantly higher, with an odds ratio (OR) of 193 (95% confidence interval (CI) 137.6-270.9). The strongest risk factors for feeding problems were the number of days on mechanical ventilation during the first 8 postnatal weeks, OR of 1.59 (CI 95% 1.29-1.98), and the Clinical Risk Index for Babies-score, OR of 1.14 (CI 95% 1.03-1.26). CONCLUSIONS Post-discharge feeding problems and underweight are common in children born extremely preterm. The strongest perinatal risk factor for later feeding problems was early treatment with mechanical ventilation. Identifying infants at risk of post-discharge feeding problems might be useful for targeting of nutritional support.
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Affiliation(s)
- Stina Alm
- From the Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | | | - Magnus Domellöf
- From the Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
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9
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Connell A, Knudsen K, Marginean H, Raddish M. Associations between feeding and development in preterm infants in the NICU and throughout the first year of life. Early Hum Dev 2023; 177-178:105719. [PMID: 36774728 DOI: 10.1016/j.earlhumdev.2023.105719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is little published evidence regarding associations between feeding and development in preterm infants which could help identify infants most needing follow-up services. AIMS To determine if preterm infant feeding and development were predictable throughout the first year of life and identify associations with maternal factors, neonatal factors, and socioeconomic measures. STUDY DESIGN Prospective single-site study of the feeding and development of extremely and very preterm infants at three time points throughout the first year of life. SUBJECTS Infants <32 weeks gestational age were followed from neonatal intensive care unit (NICU) discharge (DC) until 12 months corrected gestational age (CGA). OUTCOME MEASURES Feeding and development were evaluated at NICU DC, 3 months and 12 months CGA. Maternal health, infant health, and socioeconomic measures were also recorded. RESULTS Significant differences were found between assessments for feeding and development at each of the three time points: NICU DC (p = 0.026), 3 months CGA (p = 0.001), and 12 months CGA (p = 0.000); however, no associations were found between feeding and development at NICU DC and 12 months CGA (p = 0.137). Of the maternal factors determined to be significant, none were consistent enough as to be considered relevant. CONCLUSIONS This study demonstrated that preterm infants with typical feeding and development at DC may go on to develop concerns in these areas, and those who scored abnormally at DC may perform typically during the first year of life. This study affirms the importance of NICU follow-up services to support feeding and development for all infants born <32 weeks gestation.
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Affiliation(s)
- Ashleigh Connell
- Providence Children's Development Institute, Providence St Vincent Medical Center NICU, United States of America.
| | - Kati Knudsen
- Providence Children's Development Institute, Providence St Vincent Medical Center NICU, United States of America
| | - Horia Marginean
- Providence Brain and Spine Institute, Providence St Joseph Health, United States of America
| | - Michele Raddish
- Providence Children's Development Institute, United States of America
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10
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Onesimo R, Sforza E, Giorgio V, Rigante D, Kuczynska E, Leoni C, Proli F, Agazzi C, Limongelli D, Cerchiari A, Tartaglia M, Zampino G. Predicting the clinical trajectory of feeding and swallowing abilities in CHARGE syndrome. Eur J Pediatr 2023; 182:1869-1877. [PMID: 36800035 PMCID: PMC10167171 DOI: 10.1007/s00431-023-04841-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 01/11/2023] [Accepted: 01/21/2023] [Indexed: 02/18/2023]
Abstract
UNLABELLED To date, the feeding and oral-motor abilities of patients with CHARGE syndrome (CS) have not been longitudinally assessed. This study aims to investigate the level of these abilities at different ages and evaluate how they evolve during growth. We retrospectively analysed oral-motor features of 16 patients with molecularly confirmed CS (age range 4-21 years old; mean 11 years; SD 6 years; median 10 years). Nearly 100% of CS new-borns had weak sucking at birth, and half of them demonstrated poor coordination between breathing and swallowing. Over time, the percentages of children with tube feeding dependence (60% at birth) faced a slow but steady decrease (from 33% at 6 months, 25% at 12 months, to 13% at school age) in tandem with the decreasing risk of aspiration. The ability of eating foods requiring chewing was achieved at school age, after the acquisition of an adequate oral sensory processing. A mature chewing pattern with a variety of food textures was not achieved by more than half of patients, including those requiring artificial enteral nutrition. Most patients started prolonged oral-motor treatments with speech language therapists in early childhood. CONCLUSIONS Although feeding and swallowing disorders are constant features in CS patients, a slow and gradual development of feeding abilities occurs in most cases. Rehabilitation plays a key role in overcoming structural and functional difficulties and attaining appropriate eating skills. WHAT IS KNOWN • Feeding problems and swallowing dysfunction have been noted in CHARGE syndrome. • The involvement of multiple factors, including structural problems in the mouth, throat, or esophagus, and neurological impairment, make feeding a complicated task in CHARGE individuals. WHAT IS NEW • Dysphagia gradually improves in most CHARGE children over time, though with a wide interindividual variability. • The percentages of children with tube feeding dependence decrease over time from 60% at birth to 33% at 6 months and 13% at school age.
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Affiliation(s)
- R Onesimo
- Center for Rare Diseases, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli-IRCCS, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Vito 1, 00168, Rome, Italy.,Pediatric Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168, Rome, Italy
| | - E Sforza
- Università Cattolica del Sacro Cuore, Largo Vito 1, 00168, Rome, Italy.
| | - V Giorgio
- Center for Rare Diseases, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli-IRCCS, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Vito 1, 00168, Rome, Italy.,Pediatric Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168, Rome, Italy
| | - D Rigante
- Center for Rare Diseases, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli-IRCCS, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Vito 1, 00168, Rome, Italy.,Pediatric Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168, Rome, Italy
| | - E Kuczynska
- Center for Rare Diseases, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli-IRCCS, 00168, Rome, Italy
| | - C Leoni
- Center for Rare Diseases, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli-IRCCS, 00168, Rome, Italy.,Pediatric Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168, Rome, Italy
| | - F Proli
- Pediatric Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168, Rome, Italy
| | - C Agazzi
- Pediatric Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168, Rome, Italy
| | - D Limongelli
- Pediatric Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168, Rome, Italy
| | - A Cerchiari
- Feeding and Swallowing Services Unit, Dept. Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital-IRCCS, 00168, Rome, Italy
| | - M Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù IRCCS, 00168, Rome, Italy
| | - G Zampino
- Center for Rare Diseases, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli-IRCCS, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Vito 1, 00168, Rome, Italy.,Pediatric Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, 00168, Rome, Italy
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11
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[Feeding and growth patterns in preterm children at 3-4 years of age]. NUTR HOSP 2023. [PMID: 36748415 DOI: 10.20960/nh.04244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
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.
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Mendoza Carretero R, Sáenz-Rico de Santiago B. La habilidad lingüística en prematuros extremos en edad escolar. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2023. [DOI: 10.5209/rlog.80476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
En España, el número de nacimientos prematuros es de 30.000, siendo una de las principales causas de mortalidad perinatal. En los últimos años, gracias a los avances médicos, la tasa de supervivencia de esta población se ha visto incrementada, lo cual ha evidenciado la aparición de nuevas morbilidades y comorbilidades que pueden interferir en su proceso de aprendizaje. Este estudio, de carácter cualitativo y longitudinal, cuenta con un muestreo no probabilístico por conveniencia. Su objeto es analizar la habilidad lingüística de cuatro menores grandes prematuros, con una edad gestacional al nacimiento igual o inferior a las 28 semanas, que actualmente cursan 4º de Educación Primaria, para detectar posibles dificultades en la adquisición y en el uso del lenguaje. Se les administró la Batería del Lenguaje Objetiva y Criterial Revisado (BLOC-SR) a la edad cronológica de 8 y 10 años. Los resultados sugieren que existen dificultades en la adquisición de los componentes del lenguaje: en el morfológico, por ejemplo, aparece en el uso de las formas verbales, en los sustantivos derivados, etc.; en el sintáctico, en las oraciones subordinadas de causa y condición, etc.; en el semántico se evidencian en los locativos, etc., y en el pragmático, en la realización de preguntas. A modo de conclusión, los menores prematuros extremos, debido a su condición de vulnerabilidad biológica al quedar interrumpida la maduración cerebral por su nacimiento temprano, necesitan potenciar las destrezas lingüísticas, entre las que destaca la conciencia semántica, siendo necesario diseñar propuestas de intervención para el ámbito escolar.
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13
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Enteral tube feeding selection at NICU discharge and resource utilization. J Perinatol 2022; 43:647-652. [PMID: 36435925 DOI: 10.1038/s41372-022-01566-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate resource utilization in infants discharged with different forms of feeding access. STUDY DESIGN Retrospective chart review of neonates discharged from 2012 to 2018. Data were collected from the medical record and relevant outcomes were compared. RESULTS 300 patients were sampled. 196 (65%) were discharged on NG feeds, 95 (32%) via GT, and 9 gastrojejunal (GJ 3%). NG-fed infants discharged sooner (mean DOL: NG = 85.4 vs GT = 122.8, p < 0.001). More GT/GJ patients required emergency department (ED) visits for tube complications (GT = 61 vs GJ = 7 vs NG = 42, p < 0.001) and more frequently (mean visits: GT = 1.63 ± 2.33 vs GJ = 4.22 ± 4.44 vs NG = 0.48 ± 1.40, p < 0.001). However, 44 (24%) of the patients discharged on NG later had a GT placed. CONCLUSIONS Many patients discharged from the NICU can be supported with NG feeds. This may shorten hospital stays and decrease ED visits but select patients will later merit surgical tube placement.
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Chen G, Li X, Pan R. Prefeeding interventions improve oral feeding in preterm infants. Int J Pediatr Otorhinolaryngol 2022; 162:111324. [PMID: 36137472 DOI: 10.1016/j.ijporl.2022.111324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess whether oral stimulation (OS), nonnutritive sucking (NNS) and combined tactile/kinesthetic (T/K) interventions can improve the effects of oral feeding in preterm infants. METHODS A retrospective review was performed from 2014 to 2016, in which one hundred thirty preterm infants were separated into two intervention groups (the OS + NNS group and the OS + NNS + T/K group) and one control group. Infants in the two intervention groups received 30 min of interventions a day. All interventions started 48 h after stopping nasal continuous positive airway pressure until participants reached complete oral feeding. RESULTS The transition times of the OS + NNS, OS + NNS + T/K, and control groups from the introduction of oral feeding to independent oral feeding were 9.03 ± 0.58, 7.20 ± 0.28, and 12.17 ± 0.64 days, respectively (P < 0.05). The infants' weights at full oral feeding in the OS + NNS, OS + NNS + T/K, and control groups were 1834.58 ± 47.96, 1999.17 ± 92.62, and 1725.87 ± 40.34 g, respectively (P = 0.007). Further post hoc analyses indicated that the weight gain at full oral feeding in the OS + NNS and OS + NNS + T/K groups were more significant than the control group (P = 0.012 and P = 0.036, respectively)Conclusion: OS + NNS and OS + NNS + T/K interventions could shorten the transition time from tube feeding to independent oral feeding; OS + NNS and OS + NNS + T/K interventions improved weight gain compared to the control group. Furthermore, the OS + NNS + T/K group was superior to the OS + NNS group regarding transition time and weight gain.
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Affiliation(s)
- Gaoyan Chen
- Department of Pediatrics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Xiaogang Li
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Rui Pan
- Department of Pediatrics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China.
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15
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Hendson L, Church PT, Banihani R. Le suivi de l'extrême prématuré après le congé des soins intensifs néonatals. Paediatr Child Health 2022; 27:359-371. [PMID: 36200102 PMCID: PMC9528784 DOI: 10.1093/pch/pxac059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/13/2021] [Indexed: 11/05/2022] Open
Abstract
La survie des extrêmes prématurés (moins de 28 semaines d'âge gestationnel) s'est améliorée au fil du temps. Bon nombre s'en sortent bien et ont une bonne qualité de vie. Ils demeurent toutefois vulnérables à des problèmes de santé, y compris des difficultés neurosensorielles et neurodéveloppementales, que les médecins de première ligne, les pédiatres et les cliniques spécialisées doivent surveiller. Le présent document de principes passe en revue les conséquences médicales et neurodéveloppementales potentielles pour les extrêmes prématurés dans les deux ans suivant leur congé et fournit des stratégies de counseling, de dépistage précoce et d'intervention. Parce qu'ils sont tous liés à l'extrême prématurité, la dysplasie bronchopulmonaire ou les troubles respiratoires, les problèmes d'alimentation et de croissance, le développement neurosensoriel (vision et audition), la paralysie cérébrale et le trouble du spectre de l'autisme doivent faire rapidement l'objet d'une évaluation. Pour évaluer la croissance et le développement, il faut corriger l'âge chronologique en fonction de l'âge gestationnel jusqu'à 36 mois de vie. Par ailleurs, l'attention au bien-être émotionnel des parents et des proches fait partie intégrante des soins de qualité de l'extrême prématuré.
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Affiliation(s)
- Leonora Hendson
- Société canadienne de pédiatrie, comité d'étude du fœtus et du nouveau-né, Ottawa (Ontario)Canada
| | - Paige T Church
- Société canadienne de pédiatrie, comité d'étude du fœtus et du nouveau-né, Ottawa (Ontario)Canada
| | - Rudaina Banihani
- Société canadienne de pédiatrie, comité d'étude du fœtus et du nouveau-né, Ottawa (Ontario)Canada
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Hendson L, Church PT, Banihani R. Follow-up care of the extremely preterm infant after discharge from the neonatal intensive care unit. Paediatr Child Health 2022; 27:359-371. [PMID: 36200103 PMCID: PMC9528778 DOI: 10.1093/pch/pxac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/13/2021] [Indexed: 11/07/2022] Open
Abstract
The survival of babies born extremely preterm (EP, <28 weeks gestation) has improved over time, and many have good outcomes and quality of life. They remain at risk for health issues, including neurosensory and neurodevelopmental difficulties requiring monitoring by primary physicians, paediatricians, and specialty clinics. This statement reviews potential medical and neurodevelopmental consequences for EP infants in the first 2 years after discharge and provides strategies for counselling, early detection, and intervention. EP-related conditions to assess for early include bronchopulmonary dysplasia or respiratory morbidity, feeding and growth concerns, neurosensory development (vision and hearing), cerebral palsy, and autism spectrum disorder. Correction for gestational age should be used for growth and development until 36 months of age. Integral to quality care of the child born EP is attention to the emotional well-being of parents and caregivers.
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Affiliation(s)
- Leonora Hendson
- Canadian Paediatric Society Fetus and Newborn Committee, Ottawa, Ontario, Canada
| | - Paige T Church
- Canadian Paediatric Society Fetus and Newborn Committee, Ottawa, Ontario, Canada
| | - Rudaina Banihani
- Canadian Paediatric Society Fetus and Newborn Committee, Ottawa, Ontario, Canada
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17
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Baldassarre ME, Panza R, Cresi F, Salvatori G, Corvaglia L, Aceti A, Giannì ML, Liotto N, Ilardi L, Laforgia N, Maggio L, Lionetti P, Agostoni C, Orfeo L, Di Mauro A, Staiano A, Mosca F. Complementary feeding in preterm infants: a position paper by Italian neonatal, paediatric and paediatric gastroenterology joint societies. Ital J Pediatr 2022; 48:143. [PMID: 35932061 PMCID: PMC9354266 DOI: 10.1186/s13052-022-01275-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
Nutrition in the first 1000 days of life is essential to ensure appropriate growth rates, prevent adverse short- and long-term outcomes, and allow physiologic neurocognitive development. Appropriate management of early nutritional needs is particularly crucial for preterm infants. Although the impact of early nutrition on health outcomes in preterm infants is well established, evidence-based recommendations on complementary feeding for preterm neonates and especially extremely low birth weight and extremely low gestational age neonates are still lacking. In the present position paper we performed a narrative review to summarize current evidence regarding complementary feeding in preterm neonates and draw recommendation shared by joint societies (SIP, SIN and SIGENP) for paediatricians, healthcare providers and families with the final aim to reduce the variability of attitude and timing among professionals.
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Affiliation(s)
- Maria Elisabetta Baldassarre
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Policlinico Hospital - Piazza Giulio Cesare n. 11, 70124, Bari, Italy
| | - Raffaella Panza
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Policlinico Hospital - Piazza Giulio Cesare n. 11, 70124, Bari, Italy. .,Neonatology and Neonatal Intensive Care Unit, "A. Perrino" Hospital, Brindisi, Italy.
| | - Francesco Cresi
- Neonatology and Neonatal Intensive Care Unit, Department of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Guglielmo Salvatori
- Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luigi Corvaglia
- Department of Medical and Surgical Sciences - University of Bologna, Neonatal Intensive Care Unit - IRCCS AOUBO, Bologna, Italy
| | - Arianna Aceti
- Department of Medical and Surgical Sciences - University of Bologna, Neonatal Intensive Care Unit - IRCCS AOUBO, Bologna, Italy
| | - Maria Lorella Giannì
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
| | - Nadia Liotto
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122, Milan, Italy
| | - Laura Ilardi
- Neonatology and Neonatal Intensive Care Unit ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nicola Laforgia
- Department of Interdisciplinary Medicine - Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, 70124, Bari, Italy
| | - Luca Maggio
- UOC Neonatology and Neonatal Intensive Care Unit, AO San Camillo Forlanini, Rome, Italy
| | - Paolo Lionetti
- Gastroenterology Unit, NEUROFARBA Department, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Intermediate Care Unit, Milan, Italy
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, "San Giovanni Calibita Fatebenefratelli" Hospital, Isola Tiberina, Rome, Italy
| | - Antonio Di Mauro
- Paediatric Primary Care, National Paediatric Health Care System, Via Conversa 12, Margherita di Savoia, BT, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Paediatrics, University of Naples "Federico II", Naples, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
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18
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Talej M, Smith ER, Lauria ME, Chitale R, Ferguson K, He S. Responsive Feeding for Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis. Pediatrics 2022; 150:188648. [PMID: 35921679 DOI: 10.1542/peds.2022-057092f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Responsive feeding may improve health outcomes in preterm and low birth weight (LBW) infants. Our objective was to assess effects of responsive compared with scheduled feeding in preterm and LBW infants. METHODS Data sources include PubMed, Scopus, Web of Science, CINAHL, LILACS, and MEDICUS. Randomized trials were screened. Primary outcomes were mortality, morbidity, growth, neurodevelopment. Secondary outcomes were feed intolerance and duration of hospitalization. Data were extracted and pooled with random-effects models. RESULTS Eleven eligible studies were identified, and data from 8 randomized control trials with 455 participants were pooled in the meta-analyses. At discharge, the mean difference in body weight between the intervention (responsive feeding) and comparison (scheduled feeding) was -2.80 g per day (95% CI -3.39 to -2.22, I2 = 0%, low certainty evidence, 4 trials, 213 participants); -0.99 g/kg per day (95% CI -2.45 to 0.46, I2 = 74%, very low certainty evidence, 5 trials, 372 participants); -22.21 g (95% CI -130.63 to 86.21, I2 = 41%, low certainty evidence, 3 trials, 183 participants). The mean difference in duration of hospitalization was -1.42 days (95% CI -5.43 to 2.59, I2 = 88%, very low certainty evidence, 5 trials, 342 participants). There were no trials assessing other growth outcomes (eg, length and head circumference) mortality, morbidity or neurodevelopment. Limitations include a high risk of bias, heterogeneity, and small sample size in included studies. CONCLUSIONS Overall, responsive feeding may decrease in-hospital weight gain. Although the evidence is very uncertain, responsive feeding may slightly decrease the duration of hospitalization. Evidence was insufficient to understand the effects of responsive compared with scheduled feeding on mortality, morbidity, linear growth, and neurodevelopmental outcomes in preterm and LBW infants.
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Affiliation(s)
- Megan Talej
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Emily R Smith
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Molly E Lauria
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia.,ICF International, Rockville, Maryland
| | - Ramaa Chitale
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Kacey Ferguson
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Siran He
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
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19
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Robinson L, Heng L, Fucile S. Investigating the Developmental Trajectory of Long-term Oral Feeding Problems in 'Healthy' Preterm Infants. Dev Neurorehabil 2022; 25:309-313. [PMID: 35034546 DOI: 10.1080/17518423.2021.2011975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the occurrence of oral feeding problems in preterm infants up to one year after hospital discharge. METHODS Thirty-six infants born <34 weeks gestation were enrolled in a prospective exploratory longitudinal pilot study prior to hospital discharge. Parents of eligible infants completed telephone questionnaires at 3, 6, and 12 months corrected gestational age. The occurrence and type of feeding problems; medical problems; and rehabilitation services received were collected. RESULTS A total of 26 (72.2%) parents responded, with 11 (42%) identifying feeding problems that developed within the first year of life. Avoidant behavior (including crying, agitated/fussy, and refusing to eat) was the most common feeding problem that occurred. CONCLUSION Feeding problems in 'healthy' preterm infants may occur at any point in development within the first year of life. Increased screening after hospitalization is needed for early identification and to make appropriate referrals in a timely manner to prevent and/or reduce the severity of long-term feeding problems.
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Affiliation(s)
| | - Lydia Heng
- Queen's University, Kingston, ON, Canada
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20
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The Influence of Parent Education on the Neurobehavior and Sucking Reflexes of Very Preterm Infants. Brain Sci 2022; 12:brainsci12070840. [PMID: 35884647 PMCID: PMC9313055 DOI: 10.3390/brainsci12070840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/15/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022] Open
Abstract
The diagnosis of neurobehavioral problems in very preterm neonates helps with planning and applying proper and direct therapeutic interventions. (1) Background: The aim of this study was to determine the direct impact of neurobehavior on the sucking reflex and eating abilities of neonates. (2) Methods: We assessed 18 preterm neonates twice hospitalized at the Gynecology and Obstetrics Clinical Hospital through the use of the Neonatal Behavioral Assessment Scale (NBAS). (3) Results: We found that that a neonate’s sucking ability positively correlated with the activity level item from the motor system cluster of the NBAS. (4) Conclusions: Neurobehavior should be closely assessed in very preterm neonates. Firstly, because assessments can detect fundamental problems and help a practitioner plan for early intervention. Secondly, the education of parents regarding the neurobehavior of their child can help in the facilitation of feeding skills and the planning of early rehabilitation.
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21
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Raczyńska A, Gulczyńska E, Talar T. Advantages of side-lying position. A comparative study of positioning during bottle-feeding in preterm infants (≤34 weeks GA). JOURNAL OF MOTHER AND CHILD 2022; 25:269-276. [PMID: 35675828 PMCID: PMC9444194 DOI: 10.34763/jmotherandchild.20212504.d-22-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/12/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The quality and safety of bottle-feeding in premature infants can be improved by optimal positioning. This study analysed the advantages of side-lying position (SLP) and semielevated position (SEP) during bottle-feeding in premature infants. MATERIAL AND METHODS A total of 42 neonates (n=42) born ≤34 weeks of gestational age were included in the study. Four feeding sessions-two in SLP and two in SEP- were analysed for each newborn. The level of saturation (SpO2) and heart rate, which are the parameters assessing the physiological stability, were measured in the studied newborns. The other factors that were examined to determine the quality of feeding included the total time of decline of SpO2 to ≤85%, level of the newborn's alertness measured using the Neonatal Behavioral Assessment Scale, and the frequency of choking episodes. The proportion of milk consumed (volume of milk consumed relative to the volume expected) and the feeding duration as well as the total time of feeding session were recorded. RESULTS SLP was safer in terms of the frequency of choking episodes. Choking episodes were more frequently observed with feeding in SEP (p<0.001). Moreover, the proportion of milk consumed by infants was statistically significantly higher in SLP (p<0.046) compared to SEP. No significant differences in the other tested parameters were noted in infants fed in SLP and infants fed in SEP. CONCLUSIONS This study demonstrated that SLP is effective in reducing the number of choking episodes during feeding. The proportion of milk consumed was better when the neonates were fed in SLP.
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Affiliation(s)
- Anna Raczyńska
- Department of Neonatology, Pathology and Neonatal Intensive Care Unit, Polish Mother’s Memorial Hospital – Research Institute, Łódź, Poland, E-mail:
| | - Ewa Gulczyńska
- Department of Neonatology, Pathology and Neonatal Intensive Care Unit, Polish Mother’s Memorial Hospital – Research Institute, Łódź, Poland
| | - Tomasz Talar
- Department of Neonatology, Pathology and Neonatal Intensive Care Unit, Polish Mother’s Memorial Hospital – Research Institute, Łódź, Poland
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Abstract
Intestinal failure (IF) secondary to short bowel syndrome is a challenging and complex medical condition with significant risk for surgical and medical complications. Significant advancements in the care of this patient population have led to improved survival rates. Due to their intensive medical needs children with IF are at risk for long-term complications that require comprehensive management and close monitoring. The purpose of this paper is to review the available literature emphasizing the surgical aspects of care for children with IF secondary to short bowel syndrome. A key priority in the surgical care of this patient population includes strategies to preserve available bowel and maximize its function. Utilization of novel surgical techniques and autologous bowel reconstruction can have a significant impact on children with IF secondary to short bowel syndrome related to the function of their bowel and ability to achieve enteral autonomy. It is also important to understand the potential long-term complications to ensure strategies are put in place to mitigate risk with early detection to improve long-term outcomes.
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Affiliation(s)
- Christina Belza
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Canada
| | - Paul W Wales
- Division of General and Thoracic Surgery, Cincinatti Children's Hospital Medical Center, University of Cincinnati, Cincinnatii, USA; Cincinnati Children's Intestinal Rehabilitation Program, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 2023, Cincinnati, Ohio 45229, USA.
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23
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Galai T, Friedman G, Moses M, Shemer K, Gal DL, Yerushalmy-Feler A, Lubetzky R, Cohen S, Moran-Lev H. Demographic and clinical parameters are comparable across different types of pediatric feeding disorder. Sci Rep 2022; 12:8596. [PMID: 35597792 PMCID: PMC9124187 DOI: 10.1038/s41598-022-12562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/05/2022] [Indexed: 11/09/2022] Open
Abstract
Knowledge and understanding of risk mechanisms associated with pediatric feeding disorder (PFD) remain limited. We aimed to investigate factors associated with PFD and their relation to specific PFD types according to the recent consensus WHO-based definition. We retrospectively reviewed the medical records of children with PFD and retrieved their demographic and clinical characteristics. Healthy age- and sex-matched children served as controls. Included were 254 children with PFD [median (interquartile range) age 16.4 (9.5-33) months at diagnosis] and 108 children in the control group [median age 24.85 (14.5-28.5) months]. According to the WHO-based definition, disturbances in oral intake were predominantly related to nutritional dysfunction in 118 (46.6%), feeding skill dysfunction in 83 (32.3%), medical conditions in 42 (16.7%) and psychosocial dysfunction in 11 (4.4%). In multivariate analysis, children with PFD had a higher risk for lower socioeconomic background (P < 0.01) and low birth weight (26.8% compared to 7.4%, P < 0.001). Moreover, significantly fewer children in the PFD group were breastfed (75% versus 89%, P = 0.003). There were no significant differences in any of those variables between PFD types. In conclusion, low socioeconomic status, lack of breastfeeding, and low birth weight were significantly more frequent in children with PFD. PDF manifest as multiple dysfunctions, thus highlighting the need to offer these children and their families multidisciplinary care.
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Affiliation(s)
- Tut Galai
- Department of Pediatric Gastroenterology, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Friedman
- Department of Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Moses
- Department of Pediatric Gastroenterology, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kim Shemer
- Department of Pediatric Gastroenterology, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana L Gal
- Department of Pediatric Gastroenterology, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Yerushalmy-Feler
- Department of Pediatric Gastroenterology, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Lubetzky
- Department of Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Cohen
- Department of Pediatric Gastroenterology, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Moran-Lev
- Department of Pediatric Gastroenterology, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel. .,Department of Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Risk Factors Associated With Long-term Feeding Problems in Preterm Infants: A Scoping Review. Adv Neonatal Care 2022; 22:161-169. [PMID: 33783383 DOI: 10.1097/anc.0000000000000864] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infants who are born preterm are at a high risk of encountering feeding problems. PURPOSE The aim of this scoping review is to identify risk factors associated with feeding problems that persist beyond infancy in children (aged 1-6 years) who were born preterm (<37 weeks' gestation). METHODS To perform this scoping review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework was applied. To be included in this study, articles had to be published in peer-reviewed journals, had an empirical study design, examined feeding problems relating to the child's feeding ability or refusal to eat certain texture of foods, and assessed risk factors (age, weight, and medical conditions) associated with long-term feeding problems in children who were born preterm. RESULTS After abstract and full-text screening, a total of 9 articles meeting the inclusion criteria were included in this study. Findings from this study identified that gestational age and birth weight are significant risk factors and that sex, duration of mechanical ventilation, and length of tube feedings are potential risk factors. IMPLICATIONS FOR PRACTICE This study confirms that younger and smaller infants are at a high risk of encountering oral feeding difficulties and early interventions services should be focused on these preterm infants. IMPLICATIONS FOR RESEARCH Evaluation of timing and intensity (dose) of early interventions strategies should be investigated to provide more targeted and effective interventions for younger and smaller preterm infants.
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Walton K, Daniel AI, Mahood Q, Vaz S, Law N, Unger SL, O'Connor DL. Eating Behaviors, Caregiver Feeding Interactions, and Dietary Patterns of Children Born Preterm: A Systematic Review and Meta-Analysis. Adv Nutr 2022; 13:875-912. [PMID: 35157009 PMCID: PMC9156386 DOI: 10.1093/advances/nmac017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/26/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Infants born preterm (<37 weeks of gestation) often experience feeding problems during hospitalization. Whether difficulties persist or have long-term sequelae on childhood eating is unclear. We aimed to describe the oromotor eating skills (e.g., chewing/swallowing), eating behaviors (e.g., food neophobia), food parenting practices (e.g., pressure to eat), and dietary patterns of preterm children during late infancy (6-12 mo) and early childhood (>12 mo-7 y) and to determine whether these differed from those of term-born peers. We identified 67 articles (57 unique studies) for inclusion. We used random-effects meta-analysis of proportions to examine the prevalence of oromotor eating skill and eating behavior challenges among preterm children, standard meta-analysis for comparisons with term-born peers, and the Grading of Recommendations, Assessment, Development and Evaluation approach to assess the certainty of evidence. Forty-three percent (95% CI: 24%, 62%) of infants and 25% (95% CI: 17%, 33%) of children born preterm experienced oromotor eating difficulties and 16% (95% CI: 4%, 27%) and 20% (95% CI: 11%, 28%), respectively, exhibited challenging eating behaviors. During late infancy and early childhood, oromotor eating difficulties (OR: 2.86; 95% CI: 1.71, 4.77; I2 = 67.8%) and challenging eating behaviors (OR: 1.52; 95% CI: 1.11, 2.10; I2 = 0.0%) were more common in those born preterm than in those born term: however, the certainty of evidence was very low. Owing to the low number and heterogeneity of studies, we narratively reviewed literature on food parenting and dietary patterns. Mothers of preterm infants appeared to have heightened anxiety while feeding and utilized coercive food parenting practices; their infants reportedly received less human milk, started solid foods earlier, and had poorer diet quality than term-born peers. In conclusion, meta-analyses show preterm children experience frequent oromotor eating difficulties and challenging eating behaviors throughout the early years. Given preterm birth increases risk of later obesity and diet-related chronic disease, research examining the effects of caregiver-child interactions on subsequent diet is warranted. This review was registered at www.crd.york.ac.uk/prospero/ as CRD42020176063.
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Affiliation(s)
- Kathryn Walton
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Allison I Daniel
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Quenby Mahood
- Hospital Library & Archives, Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simone Vaz
- Department of Pediatrics, William Osler Health System, Brampton, Ontario, Canada
| | - Nicole Law
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon L Unger
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada,Paediatrics, Sinai Health, Toronto, Ontario, Canada,Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Hernández Gutiérrez MF, Díaz-Gómez NM, Jiménez Sosa A, Díaz Gómez JM, Domenech Martinez E. Effectiveness of 2 interventions for independent oral feeding in preterms. An Pediatr (Barc) 2022; 96:97-105. [DOI: 10.1016/j.anpede.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/10/2020] [Indexed: 10/19/2022] Open
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Pham A, Ecochard-Dugelay E, Bonnard A, Le Roux E, Gelas T, Rousseau V, Thomassin N, Cabon-Boudard I, Nicolas A, Guinot A, Rebeuh J, Le Mandat A, Djeddi DD, Fouquet V, Boucharny A, Irtan S, Lemale J, Comte A, Bridoux-Henno L, Dupont-Lucas C, Dimitrov G, Turquet A, Borderon C, Pelatan C, Chaillou Legault E, Jung C, Willot S, Montalva L, Mitanchez D, Gottrand F, Bellaiche M. Feeding disorders in children with oesophageal atresia: a cross-sectional study. Arch Dis Child 2022; 107:52-58. [PMID: 33863700 DOI: 10.1136/archdischild-2020-320609] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION With advances in surgical and neonatal care, the survival of patients with oesophageal atresia (OA) has improved over time. Whereas a number of OA-related conditions (delayed primary anastomosis, anastomotic stricture and oesophageal dysmotility) may have an impact on feeding development and although children with OA experience several oral aversive events, paediatric feeding disorders (PFD) remain poorly described in this population. The primary aim of our study was to describe PFD in children born with OA, using a standardised scale. The secondary aim was to determine conditions associated with PFD. METHODS The Feeding Disorders in Children with Oesophageal Atresia Study is a national cohort study based on the OA registry from the French National Network. Parents of children born with OA between 2013 and 2016 in one of the 22 participating centres were asked to complete the French version of the Montreal Children's Hospital Feeding Scale. RESULTS Of the 248 eligible children, 145 children, with a median age of 2.3 years (Q1-Q3 1.8-2.9, min-max 1.1-4.0 years), were included. Sixty-one children (42%) developed PFD; 13% were tube-fed (n=19). Almost 40% of children with PFD failed to thrive (n=23). The presence of chronic respiratory symptoms was associated with the development of PFD. Ten children with PFD (16%) had no other condition or OA-related complication. CONCLUSION PFD are common in children with OA, and there is no typical profile of patients at risk of PFD. Therefore, all children with OA require a systematic screening for PFD that could improve the care and outcomes of patients, especially in terms of growth.
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Affiliation(s)
- Aurélie Pham
- AP-HP, Department of Neonatology, Armand-Trousseau Childrens Hospital, Paris, France
| | - Emmanuelle Ecochard-Dugelay
- AP-HP, Service des Maladies Digestives de l'Enfant, Hôpital Universitaire Mère-enfant Robert-Debré, Paris, France
| | - Arnaud Bonnard
- Department of General Pediatric Surgery, Robert Debre Children University Hospital, APHP, Paris, France
| | - Enora Le Roux
- AP-HP, Paris, France, Nord-Université de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, Robert-Debré Hospital, Paris, France
| | - Thomas Gelas
- Hôpital Femme-Mère-Enfant, Service de Chirurgie Pédiatrique, CHU Lyon, Lyon, France
| | - Véronique Rousseau
- Pediatric Surgery, APHP, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Nadège Thomassin
- Hépato-Gastroentérologie Pédiatrique, University Hospital Centre Grenoble Alpes, Grenoble, France
| | - Isabelle Cabon-Boudard
- AP-HM, Service de Pédiatrie, Hôpital de la Timone, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Audrey Nicolas
- Centre de Reference des Affections Chroniques et Malformatives de l'œsophage, CHU Lille, Lille, France
| | - Audrey Guinot
- Service de Chirurgie Infantile, CHU de Nantes, Hôpital Mère-enfant, Nantes, France
| | - Julie Rebeuh
- Department of Pediatrics, University Hospital Centre Strasbourg, Strasbourg, France
| | - Aurélie Le Mandat
- Service de Chirurgie Viscérale Pédiatrique, CHU de Toulouse, France, Hôpital des Enfants, Toulouse, France
| | - Djamal-Dine Djeddi
- Service de Pédiatrie Médicale, CHU Amiens Picardie, France, Pôle Femme Couple Enfant, Amiens, France
| | - Virginie Fouquet
- Paediatric Surgery, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicetre, France
| | - Aurélie Boucharny
- Service de Pédiatrie, CHU Dijon, France, Hôpital d'Enfants, Dijon, France
| | - Sabine Irtan
- Department of Pediatric Surgery, Armand-Trousseau Childrens Hospital, Paris, France
| | - Julie Lemale
- Department of Pediatric Gastroenterology, Armand-Trousseau Children's Hospital, Paris, France
| | - Aurélie Comte
- Service de Médecine Pédiatrique, CHU Besançon, Besançon, France
| | - Laure Bridoux-Henno
- Département de Médecine de l'Enfant et de l'Adolescent, CHU Rennes Unité de Nutrition, Rennes, France
| | - Claire Dupont-Lucas
- Pediatrics, Gastroenterology Unit, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Georges Dimitrov
- Service de Chirurgie Pédiatrique, CHR d'Orléans, Orléans, France
| | - Anne Turquet
- Service de Pédiatrie, CHU La Réunion, La Reunion, France
| | - Corinne Borderon
- Service de pédiatrie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Cécile Pelatan
- service de pédiatrie, CH Le Mans, Le Mans, Pays de la Loire, France
| | | | - Camille Jung
- Service de Pédiatrie, CH Intercommunal de Créteil, Creteil, France
| | - Stéphanie Willot
- Service de Médecine Pédiatrique, CHRU de Tours, Hôpital Clocheville, Tours, France
| | - Louise Montalva
- Department of General Pediatric Surgery, Robert Debre Children University Hospital, APHP, Paris, France
| | - Delphine Mitanchez
- Service de Néonatologie, CHRU de Tours, France, Hôpital Bretonneau, Tours, France
| | - Frederic Gottrand
- Centre de Reference des Affections Chroniques et Malformatives de l'œsophage, CHU Lille, Lille, France
| | - Marc Bellaiche
- AP-HP, Service des Maladies Digestives de l'Enfant, Hôpital Universitaire Mère-enfant Robert-Debré, Paris, France
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Van Schalkwyk EA, Gerber B. Vulnerable mothers' experience of feeding their preterm infant in neonatal care. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2021; 68:e1-e9. [PMID: 34797109 PMCID: PMC8603148 DOI: 10.4102/sajcd.v68i1.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/27/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022] Open
Abstract
Background Worldwide, preterm birth is a rising threat to maternal and child health. The universal challenges of being the mother of a preterm infant, combined with context-specific challenges such as poverty and poor linguistic and cultural representation, bring about risks for both mother and infant. This includes poor maternal mental health; poor mother–infant bonding and attachment and potential suboptimal developmental outcomes for the infant. Objective This article describes how Afrikaans-speaking mothers living in poverty experienced feeding their preterm infants in neonatal care. Method The study implemented a cross-sectional, qualitative design. Mothers of preterm infants (chronological ages between 3 and 6 months) were selected through a purposive sampling method and participated in individual semi-structured interviews. Nine interviews were thematically analysed. The participants were a vulnerable group, about whom little research literature was available. Results Feeding was perceived as a progressive task that worked towards the goal of discharge from the hospital. It was stressful because of various factors, but insufficient breastmilk supply was a significant contributor. The hospital setting was perceived as something that added to the participants’ anxiety surrounding feeding, but at the same time, it had the potential to decrease their anxiety. When the mother–infant dyad was able to breastfeed successfully, it made the participants feel like mothers at last after an extended period of anticipation. Conclusion Feeding their preterm infant was a prominent experience for the mothers, especially whilst in neonatal care. Increased feeding support is required from the healthcare team providing neonatal care in order to optimally use the neonatal period.
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Affiliation(s)
- Elanie A Van Schalkwyk
- Department of Speech, Language and Hearing Therapy, Faculty of Medicine and Health, Stellenbosch University, Cape Town.
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29
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Nguyen M, Brooks L, Wetzel M, Raol N. Swallowing Outcomes Following Supraglottoplasty: A Retrospective Review. Laryngoscope 2021; 131:2817-2822. [PMID: 34228358 DOI: 10.1002/lary.29704] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/20/2021] [Accepted: 06/17/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Determine the incidence of short- and long-term dysphagia in pediatric patients with and without syndromes/neurodevelopmental delay following supraglottoplasty (SGP) at our institution. STUDY DESIGN Retrospective cohort study. METHODS A retrospective cohort study of children ≤18 years old who underwent SGP from 2014 to 2019 was undertaken. Age at surgery, sex, race, insurance, underlying syndromes/neurodevelopmental delay, concurrent surgical procedures, and clinical swallowing assessments were reviewed. Logistic regression was performed to identify factors associated with postoperative feeding difficulties. Time-to-event analysis was performed to assess time to resolution of dysphagia. RESULTS A total of 231 patients were identified. Average age at time of SGP was 13.7 months. Of 231 patients, 88 (38.1%) had a syndrome/neurodevelopmental delay. Of these 231 patients, 112 had a preoperative videofluoroscopic swallow study or fiberoptic endoscopic evaluation of swallowing, of whom 53/112 (47.3%) had dysphagia. After SGP, 138/231 (59.7%) underwent clinical/instrumental swallowing assessments, of whom 95/138 (68.8%) had immediate postsurgical dysphagia. At last follow-up (1 month to 45 months), 15/95 (15.8%) had persistent dysphagia on instrumental assessment, 14/15 of whom had syndromes/neurodevelopmental delay. Time-to-event analysis revealed that for the nonsyndromic cohort, 25% had resolution of dysphagia by 4 months, 50% by 10 months, and 75% by 14 months. Cox proportional hazards regression revealed that the presence of underlying syndromes/neurodevelopmental delay was the only factor predictive of long-term postoperative dysphagia (hazard ratio of resolution 0.21 [95% confidence interval 0.096-0.48]). CONCLUSIONS While short-term feeding difficulties following SGP in pediatric patients are not uncommon, long-term dysphagia is rare in patients without syndromes/neurodevelopmental delay. These data can be used when counseling caregivers about the risks and benefits of SGP. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Mai Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Laura Brooks
- Department of Rehabilitation Services, Children's Healthcare of Atlanta, Atlanta, Georgia, U.S.A
| | - Martha Wetzel
- Division of Biostatistics, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Nikhila Raol
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.,Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Atlanta, Georgia, U.S.A
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Matharu P, Cristea AI, Slaven JE, Becker S, Niehaus JZ. Feeding Outcomes for Infants with Bronchopulmonary Dysplasia Discharged on Nasogastric Feeds. Am J Perinatol 2021; 38:897-900. [PMID: 31887745 DOI: 10.1055/s-0039-3401796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE While previous studies regarding neonatal home feeding regimens have demonstrated a more favorable prognosis for nasogastric (NG) versus gastrostomy tubes (GT), institutional practices of discharge on NG feeds are varied, particularly for infants with bronchopulmonary dysplasia (BPD). Little is known regarding the risk factors for patients treated with GT postdischarge in premature infants with BPD. Our objective was to identify frequency and risk factors for treating premature infants with BPD discharged on NG feeds with GT. STUDY DESIGN In this retrospective study, we included infants born at 30 weeks' gestational age with BPD transitioning from a tertiary care center to home on NG feeds from 2010 to 2016. RESULTS Of the 86 infants included in this study, 25 (29%) underwent GT placement at a median age of 264 days postdischarge. Fourteen (56%) were able to remove the GT at a median age of 979.5 days. Infants not requiring GT placement postdischarge were found to have a significantly higher ccipitofrontal circumference (p = 0.0089) and length (p = 0.0166) at discharge compared with infants with GT. CONCLUSION NG feeding for infants with BPD appears to be a viable treatment with fewer patients (29%) requiring GT placement. Gestational age and abnormal magnetic resonance imaging results were found to have a significant association with GT placement postdischarge.
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Affiliation(s)
- Preet Matharu
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - A Ioana Cristea
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Samantha Becker
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - Jason Z Niehaus
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
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Mohamed MA, Teumer KK, Leone M, Akram N, Rahamn MH, Abdelatif D, Condie K. Cue-Based Feeding as Intervention to Achieve Full Oral Feeding in Preterm Infants Primarily Managed with Bubble CPAP. Am J Perinatol 2021; 40:766-772. [PMID: 34130317 DOI: 10.1055/s-0041-1731046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cue-based feeding aims at matching introduction of per oral (PO) feeding with physiological readiness of preterm infants to facilitate PO intake and avoid oral aversion. It was claimed that cue-based feeding may lead to delay in the initiation or achieving full PO feeding in clinical setting primarily using bubble nasal continuous positive airway pressure (CPAP). The study aimed to examine the association of cue-based feeding with time of introduction and completing oral feeding in infants primarily managed with bubble CPAP. STUDY DESIGN A retrospective analysis where outcomes of preterm infants ≤32 weeks' gestational age (GA) and ≤2,000 g birth weight (BW) were compared after a practice change from volume-based feeding advancement to cue-based feeding. Continuous variables were compared by using t-test and multilinear regression analysis to control for confounding variables. RESULTS Of the 311 preterm infants who met inclusion and exclusion criteria, 194 were in the cue-based feeding group and 117 were in the volume-based advancement historical comparison group. There were no differences between groups regarding demographic or clinical variables. Postmenstrual age (PMA) of initial feeding assessment was less in the cue-based feeding group. Age of first PO feeding and when some PO was achieved every feed was mildly delayed in the cue-based feeding compared with comparison group, 34 (±1.3) versus 33.7 (±1.2) weeks, and 36.2 (±2.3) versus 36.0 (±2.4) weeks, (p < 0.01) respectively. However, the age of achieving full PO did not differ between groups, 36.8 (±2.2) versus 36.4 (±2.4) weeks (p = 0.13). There was no difference between groups regarding growth parameters at 36 weeks' PMA or at discharge. Similar results were obtained when examining subcategories of infants ≤1,000 g and 1,001 to 2,000 g. CONCLUSION Cue-based feeding may not be associated with a delay in achieving full oral feeding or prolongation of the length of stay in preterm infants managed with CPAP. KEY POINTS · Cue-based feeding matches introduction of PO feeding with physiological readiness.. · Cue-based feeding may not be associated with a delay in achieving full oral feeding in preterm infants.. · Cue-based feeding is not associated with prolongation of the length of stay in preterm infants.. · Cue based feeding in preterm infants managed with noninvasive bubble CPAP is examined..
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Affiliation(s)
- Mohamed A Mohamed
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Kirsten K Teumer
- Department of Rehabilitation, the George Washington University Hospital, Washington, District of Columbia
| | - Mariana Leone
- Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Nabi Akram
- Columbian College of Arts and Science, the George Washington University, Washington, District of Columbia
| | - Mohamed H Rahamn
- Columbian College of Arts and Science, the George Washington University, Washington, District of Columbia
| | - Dinan Abdelatif
- Department of Obstetrics and Gynecology, the George Washington University Hospital, Washington, District of Columbia
| | - Kimberly Condie
- Department of Rehabilitation, the George Washington University Hospital, Washington, District of Columbia
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Steinberg C, Menezes L, Nóbrega AC. Oral motor disorder and feeding difficulty during the introduction of complementary feeding in preterm infants. Codas 2021; 33:e20190070. [PMID: 33978058 DOI: 10.1590/2317-1782/20202019169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 02/17/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate the association between oral-motor disorder and feeding difficulty during the process of introducing complementary feeding in preterm infants. METHODS This is a cross-sectional, observational, and quantitative study. Preterm infants who had already begun complementary feeding and were up to 24 months corrected gestational age, were followed up at an outpatient clinic for high-risk newborns. The feeding difficulty was assessed using the mother's perception of the presence of defensive behaviors in their child. The measurement of the oral motor skills performance was obtained through the application of an adaptation of the Clinical evaluation protocol of pediatric dysphagia (PAD-PED). RESULTS The sample consisted of 62 dyads of children with a mean corrected gestational age (CGA) of 13.5 months. Complementary feeding was introduced at the sixth month CGA by almost half of the mothers and most of them reported some sort of difficulty with this activity. Extreme prematurity revealed an association with defensive feeding behavior (p = 0.005), as well as with the initial introduction of food with liquid consistency (p = 0.001), the extended period of time using enteral tube feeding (p = 0.044), the continuous positive airway pressure (CPAP) (p = 0.013) and parenteral nutrition (p = 0.039). CONCLUSION There was no significant association between oral motor disorder and feeding difficulty.
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Affiliation(s)
- Carla Steinberg
- Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
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Non-nutritive suck and voice onset time: Examining infant oromotor coordination. PLoS One 2021; 16:e0250529. [PMID: 33905427 PMCID: PMC8078818 DOI: 10.1371/journal.pone.0250529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022] Open
Abstract
The variability of a child’s voice onset time (VOT) decreases during development as they learn to coordinate upper vocal tract and laryngeal articulatory gestures. Yet, little is known about the relationship between VOT and other early motor tasks. The aims of this study were to evaluate the relationship between infant vocalization and another early oromotor task, non-nutritive suck (NNS). Twenty-five full-term infants (11 male, 14 female) completed this study. NNS was measured with a customized pacifier at 3 months to evaluate this early reflex. Measures of mean VOT and variability of VOT (measured via coefficient of variation) were collected from 12-month-old infants using a Language Environmental Analysis device. Variability of VOTs at 12 months was significantly related to NNS measures at 3-months. Increased VOT variability was primarily driven by increased NNS intraburst frequency and increased NNS burst duration. There were no relationships between average VOT or range of VOT and NNS measures. Findings from this pilot study indicate a relationship between NNS measures of intraburst frequency and burst duration and VOT variability. Infants with increased NNS intraburst frequency and NNS burst duration had increased VOT variability, suggesting a relationship between the development of VOT and NNS in the first year of life. Future work is needed to continue to examine the relationship between these early oromotor actions and to evaluate how this may impact later speech development.
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Pados BF, Hill RR, Yamasaki JT, Litt JS, Lee CS. Prevalence of problematic feeding in young children born prematurely: a meta-analysis. BMC Pediatr 2021; 21:110. [PMID: 33676453 PMCID: PMC7936467 DOI: 10.1186/s12887-021-02574-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/24/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Difficulties related to eating are often reported in children born preterm. The objective of this study was to quantitatively synthesize available data on the prevalence of problematic feeding in children under 4 years of age who were born preterm. METHODS Literature was identified from PubMed, CINAHL, and PsycInfo. The search was limited to English language and publication years 2000-2020. To be included in the meta-analysis, the article had to report the prevalence of problematic oral feeding within a population of children born prematurely (< 37 weeks' gestation), and the child age at the time of study had to be between full-term corrected age and 48 months. For studies meeting inclusion criteria, the following data were extracted: sample size and subsamples by gestational age and/or child age at time of study; definition of problematic feeding; measures used for assessment of feeding; gestational age at time of birth of sample; child age at time of study; exclusion criteria for the study; and prevalence of problematic feeding. Random-effects meta-analyses were performed to estimate the prevalence of problematic feeding across all studies, by gestational age at birth, and by child age at time of study. RESULTS There were 22 studies that met inclusion criteria. Overall prevalence of problematic feeding (N = 4381) was 42% (95% CI 33-51%). Prevalence was neither significantly different across categories of gestational age nor by child age at the time of study. Few studies used psychometrically-sound assessments of feeding. CONCLUSION Problematic feeding is highly prevalent in prematurely-born children in the first 4 years of life regardless of degree of prematurity. Healthcare providers of children born preterm should consider screening for problematic feeding throughout early childhood as a potential complication of preterm birth. SYSTEMATIC REVIEW REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Britt Frisk Pados
- Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA.
| | - Rebecca R Hill
- Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA
| | - Joy T Yamasaki
- CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Jonathan S Litt
- Beth Israel Deaconess Medical Center, Boston Children's Hospital, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA
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NICU infants who require a feeding gastrostomy for discharge. J Pediatr Surg 2021; 56:449-453. [PMID: 32828544 DOI: 10.1016/j.jpedsurg.2020.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/05/2020] [Accepted: 07/18/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine population data for infants receiving a gastrostomy tube (GT) in our Neonatal Intensive Care Unit (NICU) to better understand the premature infant population at risk for GT prior to discharge. STUDY DESIGN We identified all NICU infants born 2015-2016 who received a GT and determined the birth gestational age below which GTs were placed due to oral feeding failure secondary to prematurity-related comorbidities, rather than anomalies or other reasons. Aggregate data were used to compare infants born <30 weeks (w) gestation who received a GT with those who did not. RESULTS GTs were placed in 117 infants. More than half of the NICU patients who receive GTs were actually >32 weeks gestation; a cut-off of <30w was a good identifier for those who failed achieving full oral feeds due to prematurity-related problems. Infants born <30w (n = 282) not receiving GTs were discharged at a significantly lower postmenstrual age (36w) and lower weight (2.3 kg) compared with infants who received a GT (49w, 5 kg). CONCLUSIONS The population of premature infants born <30w gestation constitute the population of infants at risk for a GT based solely on prematurity. LEVELS OF EVIDENCE III.
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Eating Behaviors of Late and Moderately Preterm Infants at Two Years of Age and Their Associations With Mothers' Mental Health. J Pediatr Gastroenterol Nutr 2021; 72:311-315. [PMID: 32960828 DOI: 10.1097/mpg.0000000000002947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Preterm infants are at high risk for nutritional difficulties during the neonatal period and early childhood. Long-term nutritional difficulties contribute to unbalanced food intake and growth disorders and are the source of major emotional stress for the family. The aim of this study is to investigate the eating problems of late and moderately preterm (LMPT) infants at the age of 2 years, and to examine the association of these problems with the mental status of their mothers. METHODS In this cross-sectional study, group 1 included LMPT infants born between 32 and 36 + 6 weeks of gestation and Group 2 included term infants born between 37 and 41 + 6 weeks of gestation. Children's Nutrition Difficulties Questionnaire and 21-item Depression Anxiety and Stress Scales (DASS 21) were used for the detection of nutritional difficulties of infants and mothers' mental health status. RESULTS Groups 1 and 2 were consisted of 79 LMPT and 38 term infants, respectively. Late and moderately preterm infants were found to have a lower drive-to-eat and food repertoire scores as well as lower appetite and food enjoyment than term infants. Pickiness and food neophobia were found to be higher in LMPT infants than term infants. The DASS-21 scores of the mothers of the LMPT infants were higher than those of the term ones. CONCLUSIONS These findings suggest that LMPT infants have more nutritional difficulties at the age of 2 years than term infants and their mothers exhibit more emotional distress than term infant's mothers.
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Hernández Gutiérrez MF, Díaz-Gómez NM, Jiménez Sosa A, Díaz Gómez JM, Domenech Martinez E. [Effectiveness of 2 interventions for independent oral feeding in pre-terms]. An Pediatr (Barc) 2021; 96:S1695-4033(20)30520-8. [PMID: 33487564 DOI: 10.1016/j.anpedi.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Oral feeding of pre-term newborns (PTNB) is hampered by their immaturity and intercurrent diseases, which can prolong their hospital stay. The objective of this study was to assess the effectiveness of a program that combines tactile, kinesthetic and oral stimulation (T+K+OS) compared to another intervention based on exclusively oral stimulation (OS), in the time necessary to achieve independent feeding and hospital discharge. PATIENTS AND METHODS A clinical study of 2 randomized groups (OS vs. T+K+OS) was carried out on 42 PTNB with gestational age between 27-32 weeks and birth weight>900g. The stimulation programs were carried out in sessions of 15min, for 10 days. RESULTS The PTNBs in the T+K+OS group achieved independent oral feeding earlier, compared to the OS group (24.9±10.1 vs. 34.1±15.6 days, P=.02). An analysis of covariance was performed, which confirmed that the birth weight and gestational age covariates had significant effects on time to reach suction feeding (birth weight: F[1, 38]=5.79; P=.021; gestational age: F[1, 38]=14.12; P=.001) and that once its effect was controlled, the intervention continued to have a significant effect (F[1, 38]=6.07; P=.018). The T+K+OS group, compared to the OS group, achieved an earlier hospital discharge (39±15 vs. 45±18 days), although the differences were not significant (P=.21). CONCLUSIONS Combined therapies that include T+K+OS are more effective than OS alone, in order to achieve independent oral feeding in PTNBs.
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Affiliation(s)
- María Fernanda Hernández Gutiérrez
- Servicio de Rehabilitación y Fisioterapia, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
| | - N Marta Díaz-Gómez
- Facultad de Ciencias de la Salud, Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España.
| | - Alejandro Jiménez Sosa
- Unidad de Investigación, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
| | - José Miguel Díaz Gómez
- Facultad de Psicología, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
| | - Eduardo Domenech Martinez
- Profesor Honorario, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
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Kwon DR, Kwon DG, Jeong JE. Effects of Microcurrent on Oxygen Saturation by Controlling Rectus Abdominis Activity in Preterm Infant With Desaturation During Feeding: A Pilot Study. Front Pediatr 2021; 9:694432. [PMID: 34881210 PMCID: PMC8645598 DOI: 10.3389/fped.2021.694432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: To determine whether a portable microcurrent therapy device (PMTD) of the rectus abdominis muscles is effective for treating desaturation during feeding in preterm infants and to evaluate the association between initial electrical activity of respiratory muscle and long-term development delay. Methods: Twenty preterm infants with desaturation during feeding were recruited. Respiratory muscle activity was quantified by calculating the root mean square (RMS) of the electromyography. All preterm infants received a 30 min PMTD application to the rectus abdominis and diaphragm daily for 2 weeks. RMS of diaphragm and rectus abdominis, feeding volume, frequency of desaturation during feeding at baseline (pre-PMTD) and 1, 2 week post-PMTD were measured. The number of days it took to treat desaturation after PMTD was measured. A Denver developmental screening test was performed and infants were divided into 3 groups: (1) normal; (2) caution; and (3) delayed at 3months after PMTD. Results: The desaturation during feeding of all the preterm infants subsided after PMTD and the mean days took to treat desaturation was 25.4 ± 14.2 days. The RMS of diaphragm, rectus abdominis, and frequency of desaturation during feeding were significantly decreased and the feeding volume was significantly increased after PMTD (p < 0.01). The mean treatment duration for desaturation was negatively correlated with RMS of rectus abdominis at baseline and 1 week post-PMTD, respectively (Pearson's correlation coefficient = -0.461,-0.514, p-value = 0.047, 0.029). RMS of rectus abdominis of Group 3 is lower than that of group 1 and 2 (p < 0.01). Conclusions: This pilot study showed that the microcurrent therapy of rectus abdominis is an efficient therapy for the treatment of preterm infants with desaturation during feeding, especially preterm infants with higher activity of the rectus abdominis. In preterm infants with lower rectus abdominis activity, longer time is required to treat desaturation by microcurrent therapy and developmental delay is observed at months post-treatment.
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Affiliation(s)
- Dong Rak Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - Dae Gil Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - Ji Eun Jeong
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, South Korea
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Karkoutli AA, Brumund MR, Evans AK. Bronchopulmonary dysplasia requiring tracheostomy: A review of management and outcomes. Int J Pediatr Otorhinolaryngol 2020; 139:110449. [PMID: 33157458 DOI: 10.1016/j.ijporl.2020.110449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/10/2020] [Indexed: 12/27/2022]
Abstract
Bronchopulmonary Dysplasia (BPD) is a pulmonary disease affecting newborns, commonly those with prematurity or low birth weight. Its pathogenesis involves underdevelopment of lung tissue with subsequent limitations in ventilation and oxygenation, resulting in impaired postnatal alveolarization. Despite advances in care with improved survival, BPD remains a prevalent comorbidity of prematurity. In severe cases, management may involve mechanical ventilation via tracheostomy. BPD's demand for multidisciplinary care compounds the challenges in management of this condition. Here, we review existing literature: the history of disease, criteria for diagnosis, pathogenesis, and modes of treatment with a focus on the severe subtype: that which is associated with pulmonary hypertension (PAH) for which tracheostomy is often required to facilitate long-term mechanical ventilation. We review the current recommendations for tracheostomy and decannulation.
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Affiliation(s)
- Adam Ahmad Karkoutli
- Louisiana State University Health Sciences Center, School of Medicine, 533 Bolivar Street, New Orleans, LA, 70112, USA
| | - Michael R Brumund
- Pediatric Cardiology, Louisiana State University Health Sciences Center, Department of Pediatrics, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA; Children's Hospital New Orleans, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA
| | - Adele K Evans
- Pediatric Otolaryngology, Louisiana State University Health Sciences Center, Department of Otolaryngology - Head and Neck Surgery, 533 Bolivar Street, Suite 566, New Orleans, LA, 70112, USA; Children's Hospital New Orleans, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA.
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Neonatal feeding performance is related to feeding outcomes in childhood. Early Hum Dev 2020; 151:105202. [PMID: 33161344 PMCID: PMC7732130 DOI: 10.1016/j.earlhumdev.2020.105202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/18/2020] [Accepted: 09/23/2020] [Indexed: 11/21/2022]
Abstract
AIM Define relationships of early feeding performance with feeding outcomes in childhood, while assessing the predictive validity of the Neonatal Eating Outcome Assessment. STUDY DESIGN Ninety-one infants (44 preterm infants born ≤32 weeks at term-equivalent age and 47 full-term infants within 4 days of life) had feeding evaluated using the Neonatal Eating Outcome Assessment and the Neonatal Oral Motor Assessment Scale (NOMAS). At 4 years of age, 39 of these infants (22 preterm infants and 17 full-term infants; 43% follow-up rate) had parent-report measures of feeding conducted using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and Pediatric Eating Assessment Tool (PediEAT). RESULTS Lower Neonatal Eating Outcome Assessment scores were related to higher PediEAT scores (p = 0.01; r = -0.44), but were not related to BPFAS scores (p = 0.17; r = -0.23). Relationships were not detected between the NOMAS and BPFAS (p = 0.35; r = 0.17), and relationships between the NOMAS and PediEAT failed to reach significance (p = 0.06; r = 0.34). There was a relationship between the BPFAS and PediEAT scores at 4 years (p < 0.001; r = 0.66). Preterm infants performed poorer than full-term infants on the Neonatal Eating Outcome Assessment (p < 0.001) and NOMAS (p < 0.001), but no differences were detected in preterm compared to full-term performance on the BPFAS (p = 0.87) and PediEAT scores (p = 0.27). DISCUSSION Neonatal feeding performance is an important predictor of feeding outcomes at 4 years of age. The Neonatal Eating Outcome Assessment has predictive validity, and the Pediatric Eating Assessment Tool has concurrent validity with relationships to another childhood feeding tool.
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Preterm's Nutrition from Hospital to Solid Foods: Are We Still Navigating by Sight? Nutrients 2020; 12:nu12123646. [PMID: 33260838 PMCID: PMC7761406 DOI: 10.3390/nu12123646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022] Open
Abstract
As preterm birth rates are globally increasing, together with research on preterms’ peculiar needs, neonatologists are still facing the challenge of how to properly feed them. The need to strike a balance between excessive catch-up growth and extrauterine growth retardation, both leading to adverse outcomes, is made even more difficult by the broad range of preterms’ needs. Although mother’s fresh milk is undoubtedly the best nourishment, its availability during hospital stay is often lower than recommended, and its fortification at discharge is still an open issue. Formula milks are available as an alternative to breast milk. However, choosing the right formula requires a thorough evaluation of the infant’s perinatal history and targets. Last but not least, adequate timing and initiation of weaning in premature babies are still a poorly explored matter. This narrative review aims at evaluating the multitude of issues to consider when feeding preterms in the three stages of their first life: in-hospital care, discharge, and, eventually, weaning. Given the current absence of internationally shared guidelines, understanding the potential pitfalls of preterms’ nutrition could help us trace the right path for the right preterm.
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Rybak A, Sethuraman A, Nikaki K, Koeglmeier J, Lindley K, Borrelli O. Gastroesophageal Reflux Disease and Foregut Dysmotility in Children with Intestinal Failure. Nutrients 2020; 12:nu12113536. [PMID: 33217928 PMCID: PMC7698758 DOI: 10.3390/nu12113536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/16/2022] Open
Abstract
Gastrointestinal dysmotility is a common problem in a subgroup of children with intestinal failure (IF), including short bowel syndrome (SBS) and pediatric intestinal pseudo-obstruction (PIPO). It contributes significantly to the increased morbidity and decreased quality of life in this patient population. Impaired gastrointestinal (GI) motility in IF arises from either loss of GI function due to the primary disorder (e.g., neuropathic or myopathic disorder in the PIPO syndrome) and/or a critical reduction in gut mass. Abnormalities of the anatomy, enteric hormone secretion and neural supply in IF can result in rapid transit, ineffective antegrade peristalsis, delayed gastric emptying or gastroesophageal reflux. Understanding the underlying pathophysiologic mechanism(s) of the enteric dysmotility in IF helps us to plan an appropriate diagnostic workup and apply individually tailored nutritional and pharmacological management, which might ultimately lead to an overall improvement in the quality of life and increase in enteral tolerance. In this review, we have focused on the pathogenesis of GI dysmotility in children with IF, as well as the management and treatment options.
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Affiliation(s)
- Anna Rybak
- Department of Gastroenterology, the Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; (A.S.); (J.K.); (K.L.); (O.B.)
- Correspondence:
| | - Aruna Sethuraman
- Department of Gastroenterology, the Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; (A.S.); (J.K.); (K.L.); (O.B.)
| | - Kornilia Nikaki
- Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry, QMUL, 26 Ashfield Street, Whitechapel, London E1 2AJ, UK;
| | - Jutta Koeglmeier
- Department of Gastroenterology, the Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; (A.S.); (J.K.); (K.L.); (O.B.)
| | - Keith Lindley
- Department of Gastroenterology, the Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; (A.S.); (J.K.); (K.L.); (O.B.)
| | - Osvaldo Borrelli
- Department of Gastroenterology, the Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; (A.S.); (J.K.); (K.L.); (O.B.)
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Factors associated with postmenstrual age at full oral feeding in very preterm infants. PLoS One 2020; 15:e0241769. [PMID: 33175897 PMCID: PMC7657555 DOI: 10.1371/journal.pone.0241769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/21/2020] [Indexed: 02/02/2023] Open
Abstract
Aim We aimed to identify variables associated with gestational age at full oral feeding in a cohort of very preterm infants. Methods In this retrospective study, all infants born below 32 weeks of gestation and admitted to a level III neonatal unit in 2015 were included. We dichotomized our population of 122 infants through the median age at full oral feeding, and explored which variables were statistically different between the two groups. We then used linear regression analysis to study the association between variables known from the literature and variables we had identified and age at full oral feeding. Results The median postnatal age at full oral feeding was 36 6/7weeks post menstrual age (Q1-Q3 35 6/7-392/7), and was associated with the duration of hospital of stay. In the univariable linear regression, the variables significantly associated with full oral feeding were gestational age, socioeconomic status, sepsis, patent ductus arteriosus, duration of supplementary oxygen, of non-invasive and invasive ventilation, and bronchopulmonary dysplasia. In the multivariable regression analysis, duration of non-invasive ventilation and oxygen therapy, bronchopulmonary dysplasia, and patent ductus arteriosus were associated with an older age at full oral feeding, with bronchopulmonary dysplasia the single most potent predictor. Discussion Lung disease severity is a major determinant of age at full oral feeding and thus length of stay in this population. Other factors associated with FOF include socioeconomic status and patent ductus arteriosus, There is a need for research addressing evidence-based bundles of care for these infants at risk of long-lasting feeding and neurodevelopmental impairments.
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Hill RR, Park J, Pados BF. Bottle-Feeding Challenges in Preterm-Born Infants in the First 7 Months of Life. Glob Pediatr Health 2020; 7:2333794X20952688. [PMID: 32953946 PMCID: PMC7479869 DOI: 10.1177/2333794x20952688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022] Open
Abstract
Preterm infants frequently experience oral feeding challenges while in the
neonatal intensive care unit, with research focusing on infant feeding during
this hospital stay. There is little data on symptoms of problematic feeding in
preterm-born infants in the months after discharge. The purpose of this study
was to describe symptoms of problematic bottle-feeding in the first 7 months of
life in infants born preterm, compared to full-term infants. Parents of infants
less than 7 months old completed an online survey that included the Neonatal
Eating Assessment Tool—Bottle-feeding and questions about the infant’s medical
and feeding history. General linear models were used to evaluate differences in
NeoEAT—Bottle-feeding total score and subscale scores by preterm category,
considering other significant factors. Very preterm infants had more symptoms of
problematic bottle-feeding than other infants. Current age, presence of
gastroesophageal reflux, and anomalies of the face/mouth were associated with
problematic bottle-feeding.
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Affiliation(s)
- Rebecca R. Hill
- MGH Institute of Health Professions,
Boston, MA, USA
- Rebecca R. Hill, DNP, FNP-C, MGH Institute
of Health Professions, 36 First Avenue, Boston, MA 02129, USA.
| | - Jinhee Park
- William F. Connell School of Nursing,
Boston College, Chestnut Hill, MA, USA
| | - Britt F. Pados
- William F. Connell School of Nursing,
Boston College, Chestnut Hill, MA, USA
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Diniz CM, de Oliveira Lopes MV, da Silva VM, Leal LP. A Middle-Range Theory for Nurses to Diagnose Ineffective Infant Feeding Patterns. Int J Nurs Knowl 2020; 32:117-124. [PMID: 32820867 DOI: 10.1111/2047-3095.12302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/11/2020] [Accepted: 07/22/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To construct a middle-range theory, based on the Roy adaptation model, for nurses can diagnose an ineffective infant feeding pattern. DATA SOURCE Scientific findings were used through a literature review and the concepts of the Roy model. DATA SYNTHESIS The theory indicated new elements for the diagnosis: 12 etiological factors and 13 clinical indicators. Most of those are not contained in the NANDA taxonomy. CONCLUSION The middle-range theory for these diagnoses highlights the need for a review of the components present in the taxonomy. IMPLICATIONS FOR NURSING PRACTICE This approach guides research on nursing diagnoses to revise the content of the theory and to expand its concepts and elements for the diagnosis of an ineffective infant feeding pattern.
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Affiliation(s)
- Camila Maciel Diniz
- Federal University of Ceará, Brazil. 1115 Alexandre Baraúna, Fortaleza, Ceará, 60430160, Brazil
| | | | | | - Luciana Pedrosa Leal
- Federal University of Pernambuco, No number, Professor Morais Rêgo, Recife, Pernambuco, 50740-900, Brazil
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Diniz CM, Lopes MVDO, Nunes MM, Menezes APD, Silva VMD, Leal LP. A Content Analysis of Clinical Indicators and Etiological Factors of Ineffective Infant Feeding Patterns. J Pediatr Nurs 2020; 52:e70-e76. [PMID: 32008831 DOI: 10.1016/j.pedn.2020.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To analyze the content of the concepts present in the nursing diagnosis of Ineffective infant feeding pattern. DESIGN AND METHODS Content validation of nursing diagnosis based on the predictive diversity model. A methodological study of the content validation of a nursing diagnosis was based on the predictive diversity model and performed in the following three stages: conceptual definition of the phenomenon of interest; organization of the phenomenon of interest; and analysis by judges of the concepts of the phenomenon of interest. RESULTS The first two stages identified 13 clinical indicators and 12 etiological factors, which were evaluated by 23 judges. The analyses of judgments were performed according to the level of expertise of the judges. All the clinical indicators were relevant to nursing diagnosis under study. Nine causal factors were analyzed, including the level of importance to the occurrence of Ineffective infant feeding pattern. CONCLUSIONS This study analyzed the diagnostic structure of Ineffective infant feeding pattern, which were considered representative of the phenomenon of interest after evaluation by the judges. PRACTICE IMPLICATIONS The use of nursing diagnosis with accurate elements facilitates clinical reasoning and favors the development of an adequate care plan.
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Affiliation(s)
- Camila Maciel Diniz
- Federal University of Ceará, 1115 Alexandre Barauna, Fortaleza, Ceará 60430160, Brazil.
| | | | - Marília Mendes Nunes
- Federal University of Ceará, 1115 Alexandre Barauna, Fortaleza, Ceará 60430160, Brazil
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Hübl N, Costa SPD, Kaufmann N, Oh J, Willmes K. Sucking patterns are not predictive of further feeding development in healthy preterm infants. Infant Behav Dev 2020; 58:101412. [DOI: 10.1016/j.infbeh.2019.101412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
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Da Costa MA, Krüger E, Kritzinger A, Graham MA. Prevalence and associated prenatal and perinatal risk factors for oropharyngeal dysphagia in high-risk neonates in a South African hospital. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2019; 66:e1-e8. [PMID: 31793313 PMCID: PMC6890542 DOI: 10.4102/sajcd.v66i1.637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/10/2019] [Accepted: 09/23/2019] [Indexed: 11/17/2022] Open
Abstract
Background The prevalence of neonatal oropharyngeal dysphagia (OPD) in high-risk infants in lower-middle-income countries is unknown. Objectives To determine the prevalence and associated risks for OPD in high-risk neonates in order to allow timely intervention for OPD, minimising negative outcomes. Method A prospective cross-sectional observational study was conducted in an urban hospital in South Africa. Clinical feeding assessments were conducted using the Neonatal Feeding Assessment Scale with all available neonates in neonatal care. Results The sample of 81 high-risk neonates (mean chronological age = 11.7 days; standard deviation = 15.6 days) had been feeding orally for 2 days and were approaching discharge. Fifty-two participants (64.2%) had OPD. Risks likely associated with OPD included breech presentation, septicaemia and other infections, spending more than 1 day on a warm table or incubator, neurological conditions, prenatal exposure to maternal smoking, siblings with mental or neurological disability, participants with congenital disorders, preterm birth (< 37 weeks), low birth weight (< 2500 g), or retinopathy of prematurity. Conclusion An unexpected high prevalence of OPD was found in neonates already deemed ready for oral feeding and approaching discharge. Timely early involvement of the Speech-Language Therapists (SLTs) in decision-making about feeding readiness may prevent serious complications of neonatal OPD. Findings may inform South African neonatal clinicians. The study provides motivation for early intervention from SLTs before the infant and mother are discharged from high care and dispersed to communities where intervention services may be scarce.
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Affiliation(s)
- Melissa A Da Costa
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria.
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Gakenheimer-Smith L, Glotzbach K, Ou Z, Presson AP, Puchalski M, Jones C, Lambert L, Delgado-Corcoran C, Eckhauser A, Miller T. The Impact of Neurobehavior on Feeding Outcomes in Neonates with Congenital Heart Disease. J Pediatr 2019; 214:71-78.e2. [PMID: 31402138 PMCID: PMC6815703 DOI: 10.1016/j.jpeds.2019.06.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/22/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the association between neonatal neurobehavioral state and oral feeding outcomes following congenital heart disease (CHD) surgery. STUDY DESIGN This single center retrospective cohort study described neonates undergoing cardiac surgery evaluated perioperatively with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). We compared NNNS attention scores, which evaluates neonates' ability to orient and fixate on stimuli, with the feeding outcomes percentage of feeds taken orally at discharge and time to reach full oral feeds using regression analyses. Models were constructed for both preoperative and postoperative NNNS evaluations. RESULTS Between August 2015 and October 2017, 124 neonates underwent 89 preoperative and 97 postoperative NNNS evaluations. In multivariable Cox regression, higher preoperative NNNS attention scores were associated with a shorter time to achieve full oral feeds (hazard ratio 1.4; 95% CI 1.0‒2.0; P = .047). This relationship was not seen for post-operative NNNS attention scores or percentage of oral feeds at discharge. Depending on the model, younger age at surgery, increased ventilator days, increased length of stay, and single or 2-ventricle anatomy with aortic arch obstruction were associated with lower percentage of oral feeds at discharge and/or delay in full oral feeds. CONCLUSIONS Higher neonatal attention before cardiac surgery is associated with improved feeding outcomes. Prospective assessment of neonatal neurobehavioral state may be a novel approach to predict and target interventions to improve feeding outcomes in CHD. Future studies should examine the impact of intrinsic neurodevelopmental delay vs environmental adaptation on the neurobehavioral state of neonates with CHD.
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Affiliation(s)
| | - Kristi Glotzbach
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Zhining Ou
- Department of Pediatrics, University of Utah, Salt Lake City, UT; Division of Epidemiology, University of Utah, Salt Lake City, UT; Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Department of Pediatrics, University of Utah, Salt Lake City, UT; Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Michael Puchalski
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | | | - Linda Lambert
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Claudia Delgado-Corcoran
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Aaron Eckhauser
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Thomas Miller
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT
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50
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Volkert VM, Sharp WG, Clark MC, Ormand H, Rubio EK, McCracken C, Bryan L. Modified-Bolus Placement as a Therapeutic Tool in the Treatment of Pediatric Feeding Disorders: Analysis From a Retrospective Chart Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3123-3134. [PMID: 31411937 DOI: 10.1044/2019_jslhr-s-18-0268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Recognizing the need to advance the treatment of pediatric feeding disorders, an emerging area of inquiry focuses on therapeutic techniques that address expulsion and packing possibly associated with oral-motor dysfunction. In the current study, we documented the use of modified-bolus placement in the treatment of pediatric feeding disorders at an intensive, multidisciplinary day-treatment center over a 26-month period. Method The retrospective observational cohort study involved patients admitted for the assessment and treatment of chronic food refusal from August 2013 to October 2015. Results Patients (n = 23) who received modified bolus placement displayed moderate-to-severe oral-motor deficits. Use of modified-bolus placement was associated with reduced expulsion and packing of bites during meals, and treatment gains coincided with a threefold increase in grams consumed per meal. Conclusion Results provide additional support for the potential therapeutic benefits of enhancing bolus placement onto the tongue as a means to improve mealtime performance in children with pediatric feeding disorders when included as an adjunct to more traditional behavioral approaches.
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Affiliation(s)
- Valerie M Volkert
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Pediatric Feeding Disorders Program, Marcus Autism Center, Atlanta, GA
| | - William G Sharp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Pediatric Feeding Disorders Program, Marcus Autism Center, Atlanta, GA
| | - Michele Cole Clark
- Pediatric Feeding Disorders Program, Marcus Autism Center, Atlanta, GA
- Children's Healthcare of Atlanta, Inc., GA
| | - Hailey Ormand
- Pediatric Feeding Disorders Program, Marcus Autism Center, Atlanta, GA
- Behavioral Psychology Department, Kennedy Krieger Institute, Baltimore, MD
| | - Emily Kate Rubio
- Pediatric Feeding Disorders Program, Marcus Autism Center, Atlanta, GA
- Department of Counseling and Psychological Services, Georgia State University, Atlanta
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Leah Bryan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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