Factors Associated With Feeding Progression in Extremely Preterm Infants

Abstract

Background Among infants born prematurely, competence at oral feeding is necessary for growth and hospital discharge. Extremely preterm infants (EP, ≤ 28 weeks gestational age [GA]) are at risk for a variety of medical complications, which can limit the infant’s capacity to develop oral feeding competence. Objective This study examined feeding progression by assessing timing of acquisition of five early feeding milestones among EP infants, and the impact of immaturity and medical complications. Design A chart review was conducted for 94 EP infants who participated in a larger longitudinal randomized study. Feeding progression was defined as infants’ postmenstrual age (PMA) at five milestones: first enteral feeding, full enteral feeding, first oral feeding, half oral feeding, and full oral feeding. GA at birth and five medical complications (neurological risk, bronchopulmonary dysplasia [BPD], necrotizing entercolitis [NEC], patent ductus arteriosus [PDA], and gastroesophageal reflux disease [GERD]) were used as potential factors influencing the feeding progression. Linear mixed models were used to examine feeding progression across the milestones and contributions of GA at birth, and five medical complications on the progression, after controlling for milk type as a covariate. Result EP infants gradually achieved feeding milestones; however, the attainment of the feeding milestones slowed significantly for infants with younger GA at birth and the presence of medical complications, including neurological risk, BPD, NEC, and PDA, but not GERD. Milk type was a significant covariate for all analyses, suggesting infants fed with breast milk achieved each of five milestones earlier than formula-fed infants. Discussion Improved understanding of the timing of essential feeding milestones among EP infants, and the contribution of specific medical conditions to the acquisition of these milestones may allow for more targeted care to support feeding skill development.

Clinicians guide for cue‐based transition to oral feeding in preterm infants: An easy‐to‐use clinical guide

“…15 These criteria have, however, shown to compromise the infant and increase levels of anxiety and frustration for parents and caregivers. 19,21 Subjective approaches, on the other hand, include caregiver intuition, 8 physician orders, or a "light-bulb phenomena" where the infant all of a sudden "figures out" how to feed successfully. 18 The approaches described above do not consider the energy expenditure associated with the physical actions involved in bottle-feeding and scheduled processes, leading to energy needs that are higher than the fetal growth rate.…”

“…For this reason, bottle or cup feeding was introduced as precursor for breastfeeding, since the volume taken could be measured, resulting in measurable nutritional intakes judged to be sufficient to achieve a postnatal growth rate approximating that of the normal fetus of the same gestational age . These criteria have, however, shown to compromise the infant and increase levels of anxiety and frustration for parents and caregivers …”

“…The ability of a preterm infant to transition from gavage to oral feeds depends on a variety of “neurodevelopment” factors. These factors include the infant's behavioural organization, a rhythmic, coordinated suck‐swallow‐breathe pattern and cardiorespiratory regulation . Gorski et al classified preterm infant development in 3 developmental stages: turning‐in, coming‐out, and reciprocity, and only once the infant reached reciprocity will he or she be able to show signs (cues) of neurological maturity to support successful oral feeding.…”

Learning to parent from Google? Evaluation of available online health evidence for parents of preterm infants requiring neonatal intensive care

“…12 Preterm infants struggle to establish oral feeding due to immature oral and gastrointestinal systems, thereby requiring assistance with oral feeding until they can develop the necessary abilities to feed by mouth. 13 Yet, the progression between tube feeding and oral feedings remains variable both in the literature and among hospital polices. 13 Recognizing that each infant's experience is unique, it is essential to acknowledge that online health information may be incomplete, variable, or conflicting depending on the health issue it is covering.…”

“…13 Yet, the progression between tube feeding and oral feedings remains variable both in the literature and among hospital polices. 13 Recognizing that each infant's experience is unique, it is essential to acknowledge that online health information may be incomplete, variable, or conflicting depending on the health issue it is covering. Provision of online health information that is incomplete or inadequate could result in increased parental confusion, stress, and poorer care for infants if parents are unaware or unable to confirm the reliability and credibility of the information.…”