Neurodevelopmental Intervention Strategies to Improve Oral Feeding Skills in Infants With Congenital Heart Defects

Abstract

Purpose Full-term infants with congenital heart defects (CHD) are at high risk for developmental and feeding difficulties secondary to a complex combination of immature neurological structures, early surgical intervention, postsurgical complications, and disruption in typical care. Infants with CHD often present with neurobehavioral immaturity that resembles that of premature infants, resulting in difficulties in achieving stability in the physiological and behavioral subsystems. This results in poor arousal, muscle tone abnormalities, and poor state regulation, which affect their ability to achieve oral feeding readiness and progress in their oral feeding skills. In fact, a significant number of infants with CHD require supplemental tube feeding upon hospital discharge to meet their nutritional needs. However, despite these unique barriers, the feeding experience for infants with CHD is frequently overlooked and the focus tends to be on higher level oral motor and swallowing skills and volume intake. Conclusion Given the growing evidence of neurological immaturity and subsequent neurodevelopmental delays in this population, it is crucial for therapists to recognize neurobehavioral stability as a foundation for a complex neuromotor activity such as oral feeding. This article will discuss how to utilize infant neurobehavioral intervention as part of feeding treatment for children with CHD to help develop appropriate neural pathways for oral feeding.

Assessment and management of feeding difficulties for infants with complex CHD

“…101 In addition, behavioural state regulation to transition from sleep to alert state is necessary to interact with the environment and take adequate nutrition for growth. 102…”

“…Recognition of infant stress signs and use of neurodevelopmental strategies such as decreasing the challenge, providing external postural support via swaddling, reducing environmental stimulation, and providing gentle touch can facilitate a more organised response to the feeding intervention. 102,110 In addition, the Newborn Individualized Developmental Care and Assessment Program is an intervention which is theorybased and supported by scientific evidence. 111 The model focuses on detailed reading of each individual infant's behavioural cues.…”

The Influence of Parent Education on the Neurobehavior and Sucking Reflexes of Very Preterm Infants

“…The final trimester of pregnancy is especially crucial for brain development and any risk factors in utero, as prematurity may influence cerebral function. Assessments of neurological maturity, neurodevelopment, and neurobehavior as a foundation for complex neuromotor activity should include oral feeding behaviors [ 2 ].…”

Impact of umbilical cord arterial pH, gestational age, and birth weight on neurodevelopmental outcomes for preterm neonates

“…Feeding readiness behaviors (FRBs) may have an effect on future feeding efficiency in preterm infants (White-Traut et al, 2005). It is crucial for therapists to recognize neurological immaturity, neurodevelopmental delays, and neurobehavioral stability as a foundation for complex neuromotor activity such as oral feeding (Desai & Lim, 2019). Strengthening and developing a neonate's neurodevelopment may improve his or her oral feeding ability, but an intervention should be applied after first assessing his or her development and maturity (Li et al, 2020).…”

“…Even if an infant is at about 26 weeks of gestation or older, a child will still improve in his or her neurodevelopment (Ohnishi et al, 2016). Other infant characteristics such as congenital heart defects, early surgical intervention, postsurgical complications, difficulties in achieving stability in physiological and behavioral subsystems, poor arousal, muscle tone abnormalities, and poor state regulation may affect a neonate's ability to achieve oral feeding readiness (Desai & Lim, 2019).…”