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Beissel A, Denis A, Laborie S, Pillet F, Gauthier-Moulinier H, Hommey S, Tume LN, Butin M, Touzet S. Impact of a nurse education programme on oral feeding in a neonatal unit. Nurs Crit Care 2024; 29:287-295. [PMID: 36054567 DOI: 10.1111/nicc.12840] [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] [Received: 01/08/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Premature neonates often experience feeding difficulties during their hospital stay, and evidence-based interventions have been shown to improve feeding outcomes. AIM This study investigated whether an infant-cue based nurse educational feeding bundle accelerates the achievement of independent oral feeding in neonates in a neonatal intensive care unit. STUDY DESIGN A quality improvement study with a pre, during and post intervention test design. All premature neonates admitted to the unit were eligible. The feeding programme included a four-month nurse training module and nurse coaching. RESULTS A hundred and twenty-five nurses or nurse assistants attended the programme and 706 neonates were included. The median time to independent oral feeding (IOF) was 40, 36 and 37 days, respectively, for pre, during and post intervention. The reduction in time to IOF observed during the post-intervention period compared with the baseline period was significant (HR = 1.32, CI 95%: 1.01-1.74). No difference was noted in the length of hospital stay between the three study periods. CONCLUSIONS An infant-cue based nurse educational feeding bundle can promote earlier achievement of IOF in preterm neonates. RELEVANCE TO CLINICAL PRACTICE This quality improvement study demonstrates the impact that a nurse-driven intervention in neonatal care can have on improving practice. Feeding interventions involve the early introduction of oral feeding, non-nutritive sucking (NNS), and oral motor stimulation, and should be individualized for each neonate. These individualized feeding interventions applied by all nurses and assistant nurses, can facilitate the achievement of earlier independent oral feeding in preterm infants and should be included in neonatal critical care nurse education programs.
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Affiliation(s)
- Anne Beissel
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Angélique Denis
- Université Lyon I, Villeurbanne, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Sophie Laborie
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Fabienne Pillet
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | | | - Sophie Hommey
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Recherche Clinique et Épidémiologique, Lyon, France
| | - Lyvonne N Tume
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Marine Butin
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- International center for research in infectiology, INSERM U1111, CNRS UMR5308, University of Lyon 1, Lyon, France
| | - Sandrine Touzet
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Recherche Clinique et Épidémiologique, Lyon, France
- Université Lyon 1, Research on Healthcare Performance Lab, Lyon, France
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Yücel A, Küçükoğlu S, Soylu H. The Effect of Breast Milk Odor on Feeding Cues, Transition Time to Oral Feeding, and Abdominal Perfusion in Premature Newborns: A Randomised Controlled Trial. Biol Res Nurs 2024; 26:160-175. [PMID: 37682253 DOI: 10.1177/10998004231200784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE The present study was conducted to determine the effect of odor stimulation with breast milk (BM) applied to premature newborns before and during enteral feeding on feeding cues, transition time to oral feeding and abdominal perfusion. DESIGN This study was a parallel group pretest-post test randomised controlled trial (RCT). METHODS The study was conducted in the neonatal intensive care unit (NICU) in Türkiye. Study data were collected from 32 premature newborns between October 2020 and December 2021. Newborns were randomly assigned to either intervention (n = 16) or control (n = 16) groups. Odor stimulation with BM was applied to newborns in the intervention group (IG) before and during enteral feeding for 3 days. Data were collected with the Newborn Information Form, Abdominal Perfusion Follow-up Form, and Feeding Cues Follow-up Form. Yates corrected and Fisher chi-squared test, Mann-Whitney U test, Cohen Kappa statistics, Permanova analysis, and Wilcoxon test were used in the analysis. The study was registered in ClinicalTrials.gov (NCT04843293). RESULTS The frequency of feeding cues in newborns who were exposed to the odor of BM, was higher than in the control group (CG) (p < .05). The transition times to oral feeding were similar in newborns in the IG and CG (p > .05). Abdominal perfusion level of newborns in the IG was higher than the CG (p < .05), and the level of abdominal perfusion showed a significant difference in terms of group*time interaction (p < .05). CONCLUSION Our findings suggest that odor stimulation with BM will be beneficial in improving the digestive functions of premature newborns.
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Affiliation(s)
- Adalet Yücel
- Department of Nursing, Faculty of Nursing, Selcuk University, Konya, Türkiye
| | - Sibel Küçükoğlu
- Department of Nursing, Faculty of Nursing, Selcuk University, Konya, Türkiye
| | - Hanifi Soylu
- Department of Pediatrics, Faculty of Medicine, Selcuk University, Konya, Türkiye
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Spagnoli J, Dhanireddy R, Gannon E, Chilakala S. Effect of cue-based feeding on time to nipple feed and time to discharge in very low birth weight infants. Sci Rep 2023; 13:9509. [PMID: 37308556 DOI: 10.1038/s41598-023-36634-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 06/07/2023] [Indexed: 06/14/2023] Open
Abstract
The objective of this study is to evaluate the effectiveness of a cue-based feeding protocol in improving time to nipple feed and time to discharge in very low birth weight infants in a Level III Neonatal Intensive Care Unit. Demographic, feeding, and discharge data were recorded and compared between the two cohorts. The pre-protocol cohort included infants born from August 2013 through April 2016 and the post-protocol cohort included infants born from January 2017 through December 2019. 272 infants were included in the pre-protocol cohort and 314 infants in the post-protocol cohort. Both cohorts were statistically comparable in gestational age, gender, race, birthweight, prenatal care, antenatal steroid use, and rates of maternal diabetes. There were statistically significant differences between the pre- versus post-protocol cohorts in median post-menstrual age (PMA) in days at first nipple feed (PO) (240 vs 238, p = 0.025), PMA in days at full PO (250 vs 247, p = 0.015), and length of stay in days (55 vs 48, p = 0.0113). Comparing each year in the post-protocol cohort, for each outcome measure, a similar trend was noted in 2017 and 2018, but not in 2019. In conclusion, the cue-based feeding protocol was associated with a decrease in the time to first PO, time to full nipple feeds, and the length of stay in very-low-birthweight infants.
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Affiliation(s)
- Jonathan Spagnoli
- Department of Pediatrics, Division of Neonatology, The University of Tennessee Health Science Center, 201 Rout Center for Women and Newborns, 853 Jefferson Avenue, Memphis, TN, 38103, USA
| | - Ramasubbareddy Dhanireddy
- Department of Pediatrics, Division of Neonatology, The University of Tennessee Health Science Center, 201 Rout Center for Women and Newborns, 853 Jefferson Avenue, Memphis, TN, 38103, USA
- Regional One Health Rout Center for Women and Newborns, Memphis, TN, USA
| | - Emily Gannon
- Department of Pediatrics, Division of Neonatology, The University of Tennessee Health Science Center, 201 Rout Center for Women and Newborns, 853 Jefferson Avenue, Memphis, TN, 38103, USA
| | - Sandeep Chilakala
- Department of Pediatrics, Division of Neonatology, The University of Tennessee Health Science Center, 201 Rout Center for Women and Newborns, 853 Jefferson Avenue, Memphis, TN, 38103, USA.
- Regional One Health Rout Center for Women and Newborns, Memphis, TN, USA.
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Slana N, Hočevar-Boltežar I, Kornhauser-Cerar L. Risk Factors for Feeding and Swallowing Disorders in Very Low Birth Weight Infants in Their Second Year of Life. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1536. [PMID: 36363492 PMCID: PMC9697318 DOI: 10.3390/medicina58111536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/09/2022] [Accepted: 10/24/2022] [Indexed: 10/07/2023]
Abstract
Background and Objectives: This study aimed to identify the prevalence of feeding and swallowing disorders (FSD) in very low birth weight (VLBW, 1500 g or less) infants in the first two years after discharge from the maternity hospital, their possible risk factors, and the consequences of them. Materials and Methods: A total of 117 preterm children with VLBW born between 2013 and 2015 were included. The data concerning possible FSD after discharge from the hospital were obtained through accessible medical documentation for the child and a short parental questionnaire. Results: FSD was reported in 32 (27.4%) infants following discharge from the hospital but in only five children (4.3%) at a mean age of four years. Four variables (birth gestational age less than 28 weeks, birth weight equal to or less than 1000 g, birth length below 33 cm, and start of oral feeding after the 34th gestational week) were identified as risk factors for FSD after discharge. However, only birth length remained a significant predictor after being included in a binary logistic regression model (p = 0.000). Abnormal oral sensitivity and a decrease in weight to under the 10th percentile were significantly more common in the FSD group at follow-up visits at the age of about 2 years. Conclusions: FSD was still present in more than one-quarter of VLBW infants after discharge from the maternity hospital but mostly disappeared within four years. A birth gestational age under 28 weeks, weight up to 1000 g, the late beginning of per oral feeding, and a birth length below 33 cm were determined to be significant predictive factors for FSD. Having a birth length below 33 cm was associated with an almost 6.5-fold increase in the odds of having persistent FSD after discharge from the hospital. FSD in the first years of life may have an impact on the child's further growth and development.
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Affiliation(s)
- Nuša Slana
- Department for (Re)Habilitation of Children, University Rehabilitation Institute Republic of Slovenia Soča, SI-1000 Ljubljana, Slovenia
- Department of Special Education and Rehabilitation, Faculty of Education, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Irena Hočevar-Boltežar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Center Ljubljana, SI-1525 Ljubljana, Slovenia
- Department of Otorhinolaryngology and Cervicofacial Surgery, Faculty of Medicine, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Lilijana Kornhauser-Cerar
- Neonatal Intensive Care Unit, Department for Obstetrics and Gynaecology, Division for Perinatology, University Medical Center Ljubljana, SI-1525 Ljubljana, Slovenia
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Non-Pharmacological and Non-Surgical Feeding Interventions for Hospitalized Infants with Pediatric Feeding Disorder: A Scoping Review. Dysphagia 2022; 38:818-836. [PMID: 36044080 DOI: 10.1007/s00455-022-10504-7] [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: 07/26/2021] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
Abstract
Infants born prematurely or with complex medical conditions often require treatment to facilitate safe and efficient feeding. Practice is based on evidence, so frontline clinicians look to the literature to make informed clinical decisions. The aim of this scoping review was to map and describe the literature base for infant feeding and swallowing interventions and to identify areas for further research. Four electronic databases were searched from the sources' inceptions through April 2020 using a search strategy designed by a health sciences research librarian. Thirteen grey literature sources were searched and forward and backward citation chasing was performed. Inclusion criteria were English-language studies reporting non-pharmacological and non-surgical interventions for hospitalized infants. Exclusion criteria included interventions exclusively for infants with cleft lip or palate or for infants being fed exclusively though enteral feeding. Data were extracted using a form created a priori and data were reported descriptively. We reviewed 6654 abstracts: 725 were chosen for full-text review and 136 met inclusion. Most studies explored interventions for infants born prematurely (n = 128). Studies were stratified by intervention domain: bridging (n = 91) and feeding/swallowing (n = 45); intervention approach: direct (n = 72), indirect (n = 31), or combination (n = 33); and outcome: feeding performance (n = 125), physiologic stability (n = 40), and swallowing physiology (n = 12). The body of research in infant feeding has grown; however, a need remains for research focused on populations of infants with various medical complexities and for frequently used interventions that lack supporting evidence.
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Rice JL, Lefton-Greif MA. Treatment of Pediatric Patients With High-Flow Nasal Cannula and Considerations for Oral Feeding: A Review of the Literature. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2022; 7:543-552. [PMID: 36276931 PMCID: PMC9585535 DOI: 10.1044/2021_persp-21-00152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE High-Flow Nasal Cannula (HFNC) has become an increasingly common means of noninvasive respiratory support in pediatrics and is being used in infants and children with respiratory distress both inside and outside of the intensive care units. Despite the widespread use of HFNC, there remains a paucity of data on optimal flow rates and its impact on morbidity, mortality, and desired outcomes. Given the scarcity of information in these critical areas, it is not surprising that guidelines for initiation of oral feeding do not exist. This review article will review HFNC mechanisms of action, its use in specific populations and settings, and finally what is known about initiation of feeding during this therapy. CONCLUSIONS The practice of withholding oral feeding solely, because of HFNC, is not supported in the literature at the time of this writing, but in the absence of safety data from clinical trials, clinicians should proceed with caution and consider patient-specific factors while making decisions about oral feeding. Well-controlled prospective clinical trials are needed for development of best practice clinical guidelines and attainment of optimal outcomes.
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Affiliation(s)
- Jessica L. Rice
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Samane S, Yadollah ZP, Marzieh H, Karimollah HT, Reza ZM, Afsaneh A, Als H. Cue-based feeding and short-term health outcomes of premature infants in newborn intensive care units: a non-randomized trial. BMC Pediatr 2022; 22:23. [PMID: 34991513 PMCID: PMC8734045 DOI: 10.1186/s12887-021-03077-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Feedings based on behavioral cues is a method relying on infants' behavioral expressions of readiness to feed. The objective of this interventional study was to determine the effect of cue-based feeding on the short-term health outcomes of preterm infants. METHODS This quasi-experimental study utilized a historical or phase lag design. It involved 60 preterm infants admitted to an Iranian referral hospital's Level III-Newborn Intensive Care Unit (NICU) from April 2017 until January 2018. The experimental group (n = 30) received a three-step intervention of offering behavioral-cue-based oral (BCBO) feedings: Step 1 - One BCBO feeding every 12 hours for 3 days; Step 2 - Two BCBO feedings every 12 h for 3 days; and Step 3 - All feedings as BCBO feedings for 3 days. The control group received standard care feedings. Group difference data were analyzed with SPSS version 16 using descriptive and inferential statistics. RESULTS The infants' mean weight at time of discharge for the intervention and control groups were 1492.79 ± 21.65 g and 1395.71 ± 17.61 g (P = .003) respectively. The mean durations of achieving full oral feedings in the intervention and control groups were 17 ± 6 and 20 ± 11 days, respectively (P = .19). The mean frequencies of hypoxia were 1 ± 1.54 and 5 ± 9.31 respectively (P = .03) and of gavage feedings 725 ± 584 and 1846 ± 2097 respectively (P = .009). No apnea events were reported for the intervention group; the frequency of apnea in the control group was 1 ± 2.11 (P = .16). CONCLUSION The findings indicate that cue-based feeding is beneficial for preterm infants. Therefore, it is recommended that nurses employ cue-based feeding in the NICU. TRIAL REGISTRATION IRCTID: IRCT20170828035962N2. Registered 27 may 2018 - Retrospectively registered, https://en.irct.ir/trial/27024 .
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Affiliation(s)
- Sefatbaqa Samane
- Master of Newborn Intensive Care Nursing, School of Nursing and Midwifery, Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Zahed Pasha Yadollah
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hasanpour Marzieh
- Pediatric and Neonatal Intensive Care Nursing Education Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hajian- Tilaki Karimollah
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Zarkesh Mohammad Reza
- Department of Neonatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Arzani Afsaneh
- Center for Non-Communicable Pediatric Diseases, Health Research Institute, School of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Iran.
| | - Heidelise Als
- Department of Psychiatry, Harvard Medical School, Neurobehavioral Infant and Child Studies, Boston Children's Hospital, Boston, MA, USA
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Abstract
Premature infants or infants born with complex medical problems are at increased risk of having delayed or dysfunctional oral feeding ability. These patients typically require assisted enteral nutrition in the form of a nasogastric tube (NGT) during their NICU hospitalization. Historically, once these infants overcame their initial reason(s) for admission, they were discharged from the NICU only after achieving full oral feedings or placement of a gastrostomy tube. Recent programs show that these infants can be successfully discharged from the hospital with partial NGT or gastrostomy tube feedings with the assistance of targeted predischarge education and outpatient support. Caregiver opinions have also been reported as satisfactory or higher with this approach. In this review, we discuss the current literature and outcomes in infants who are discharged with an NGT and provide evidence for safe practices, both during the NICU hospitalization, as well as in the outpatient setting.
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Affiliation(s)
- Anna Ermarth
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Con Yee Ling
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
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McFadden A, Fitzpatrick B, Shinwell S, Tosh K, Donnan P, Wallace LM, Johnson E, MacGillivray S, Gavine A, Farre A, Mactier H. Cue-based versus scheduled feeding for preterm infants transitioning from tube to oral feeding: the Cubs mixed-methods feasibility study. Health Technol Assess 2021; 25:1-146. [PMID: 34878383 DOI: 10.3310/hta25740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a lack of evidence of the effect of cue-based feeding compared with scheduled feeding on important outcomes for preterm infants. OBJECTIVES The objectives were as follows: (1) to describe the characteristics, components, theoretical basis and outcomes of approaches to feeding preterm infants transitioning from tube to oral feeding; (2) to identify operational policies, barriers and facilitators, and staff and parents' educational needs in neonatal units implementing cue-based feeding; (3) to co-produce an intervention for feeding preterm infants in response to feeding cues; (4) to appraise the willingness of parents and staff to implement and sustain the intervention; (5) to assess associated costs of implementing cue-based feeding; (6) to determine the feasibility and acceptability of a future trial; (7) to scope existing data-recording systems and potential outcome measures; and (8) to determine stakeholders' views of whether or not a randomised controlled trial of this approach is feasible. DESIGN This was a mixed-methods intervention development and feasibility study comprising (1) a systematic review, case studies, qualitative research and stakeholder consensus; (2) the co-production of the intervention; (3) a mixed-methods feasibility study; and (4) an assessment of stakeholder preferences for a future evaluation. SETTING Three neonatal units in the UK (two level 3 units and one level 2 unit). PARTICIPANTS Developmentally normal, clinically stable preterm infants receiving enteral feeds (n = 50), parents (n = 15 pre intervention development; n = 14 in the feasibility study) and health-care practitioners (n = 54 pre intervention development; n = 16 in the feasibility study). INTERVENTION An evidence-informed multicomponent intervention comprising training, a feeding protocol, feeding assessment tools, supplementary training materials [including posters, a film and a narrated PowerPoint (Microsoft Corporation, Redmond, WA, USA) presentation] and the 'Our Feeding Journey' document. MAIN OUTCOME MEASURES The main outcome measures were recruitment and screening rates, infant weight gain, duration of the intervention, feeding outcomes, implementation outcomes (contextual facilitators and barriers, acceptability, adoption, appropriateness and fidelity) and stakeholder preferences for a future evaluation. RESULTS The systematic review of 25 studies concluded that evidence in favour of cue-based feeding should be treated cautiously. The case studies and qualitative research highlighted contextual barriers to and facilitators of the implementation of cue-based feeding. The telephone survey found that many neonatal units are considering implementing cue-based feeding. We recruited 37% of eligible infants, and there was good retention in the study until discharge but a high loss to follow-up at 2 weeks post discharge. The mean number of days from intervention to transition to full oral feeding was 10.8, and the mean daily change in weight gain was 25 g. The intervention was acceptable to parents and staff, although there was dissatisfaction with the study documentation. Intervention training did not reach all staff. A cluster-randomised design with a composite outcome was suggested by stakeholders for a future study. LIMITATIONS The intervention was available only in English. Intervention training did not reach all staff. There was low recruitment to qualitative interviews and observations. Only a small number of medical staff engaged in either the training or the interviews. CONCLUSIONS It is feasible to implement a cue-based feeding intervention with improved training and documentation. Further work is needed to assess the feasibility of a future trial, noting evidence of existing lack of equipoise. FUTURE WORK The next steps are to digitalise the intervention and conduct a survey of all neonatal units in the UK. STUDY REGISTRATION This study is registered as PROSPERO CRD42018097317 and ISRCTN13414304. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 74. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Shona Shinwell
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Karen Tosh
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Peter Donnan
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Louise M Wallace
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | | | | | - Anna Gavine
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Albert Farre
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Helen Mactier
- Princess Royal Maternity, NHS Greater Glasgow and Clyde, Glasgow, UK
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The Effect of Training on Neonatal Nurses' Knowledge about Transitioning Preterm Infants to Oral Feeding. J Pediatr Nurs 2021; 61:185-190. [PMID: 34111838 DOI: 10.1016/j.pedn.2021.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neonatal nurses require knowledge of evidence-based interventions that can be utilized for supporting oral feeding skills in preterm infants. Little is known about the impact of education/training programs on neonatal nurses' knowledge of this topic. PURPOSE This study was conducted to determine the effect of a training program about evidence-based interventions for the transition to and support of oral feeding in preterm infants on the knowledge levels of neonatal nurses. METHODS We conducted a pretest-posttest studywith 73 neonatal nurses in a research and training hospital. Participants completed a demographic information form and their knowledge about oral feeding in preterm infants was assessed before and after a 240-min training about the transition to oral feeding and evidence-based therapeutic interventions to promote preterm infants' oral feeding skills. RESULTS Posttest scores evaluated at 1 week (81.6 ± 6.8) and 1 month (79.5 ± 6.5) after the training were significantly higher than pre-test scores (66.8 ± 6.9) (p < 0.001). CONCLUSION Neonatal nurses showed higher levels of knowledge about evidence-based interventions for supporting oral feeding skills in preterm infants at 1 week and 1 month after the training program compared to their knowledge before training. IMPLICATIONS FOR PRACTICE Providing training to neonatal intensive care nurses on the transition to oral feeding in preterm infants will increase their level of knowledge and ensure that oral feeding interventions for preterm infants can be implemented using evidence-based therapeutic methods.
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Hahn-Holbrook J, Little EE, Abbott M. Mothers are more sensitive to infant cues after breastfeeding compared to bottle-feeding with human milk. Horm Behav 2021; 136:105047. [PMID: 34710778 DOI: 10.1016/j.yhbeh.2021.105047] [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: 09/08/2019] [Revised: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
The belief that breastfeeding promotes maternal bonding is widely held by both the public and professional health organizations. Yet to our knowledge, all research examining the link between breastfeeding and maternal behavior in humans has been correlational, limiting our ability to draw causal conclusions. In many mammals, the hormone prolactin, which is central to milk production, rises in response to each breastfeeding session and promotes maternal sensitivity, yet there is a dearth of research in human mothers. To fill these research gaps, we randomly assigned 28 breastfeeding mothers to either breastfeed in the lab or feed their infants previously expressed breastmilk in a bottle before participating in a video-recorded free play session with their infant. Plasma prolactin was measured 40 min after the start of the feeding session and video observations were coded for maternal sensitivity. We found that women randomly assigned to breastfeed were more sensitive to infant cues than women randomly assigned to bottle-feed. Prolactin levels did not differ between feeding groups, although prolactin was positively correlated with maternal sensitivity. Our results suggest that feeding milk directly from the breast (compared to bottle-feeding) increases maternal sensitivity towards infants, at least in the short term.
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Affiliation(s)
- Jennifer Hahn-Holbrook
- Department of Psychology, University of California, Merced, CA, United States of America.
| | | | - Marcia Abbott
- Department of Health Sciences, Chapman University, Orange, CA, United States of America
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Hao G, Ni A, Chang YJ, Hall K, Lee SH, Chiu HT, Yang SF, Sheu KL, Chen SC. Improve the clinical effective decision of the oral feeding readiness in preterm infants: Revise and validate the TC-POFRAS. J Neonatal Perinatal Med 2021; 15:317-325. [PMID: 34719446 DOI: 10.3233/npm-210869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Currently there is limited information to guide health professionals regarding the optimal time frame to initiate safe and effective oral feedings to preterm infants. The study aims to revise and validate a streamlined version of the Traditional Chinese-Preterm Oral Feeding Readiness Assessment Scale, the TC-POFRAS®, and evaluate its construct validity in the clinical decisions regarding feeding readiness of preterm infants. METHODS Eighty-one clinically stable preterm infants were assessed using the TC-POFRAS for oral feeding readiness. Item-total correlation analysis was used to check if any item was inconsistent with the averaged TC-POFRAS scores. Cronbach's α coefficient was used to evaluate the inter-item consistency. Exploratory factor analysis was used to determine the coherence of variables to reorganize assessment domains. The revised version of TC-POFRAS (TC-POFRAS®) was developed and a new cut-off score based on discriminant accuracy was established. RESULTS Based on the results from statistical analysis, five items ("lips posture," "tongue posture," "biting reflex," "gag reflex," and "tongue cupping") were deleted from the original TC-POFRAS to form the TC-POFRAS®. The TC-POFRAS®'s global accuracy was 92.1%. The cut-off value of 19 was the one that presented the most optimization of sensitivity based on specificity. The TC-POFRAS® was reconstructed into corrected gestational age and five behavioral domains. CONCLUSIONS The TC-POFRAS® is considered a valid, safe, and accurate objective instrument to assist health professionals to initiate oral feeding of preterm infants.
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Affiliation(s)
- G Hao
- Department of Communication Sciences and Disorders, College of Health and Sciences, North Carolina Central University, NC, USA
| | - A Ni
- Department of Communication Sciences and Disorders, College of Health and Sciences, North Carolina Central University, NC, USA
| | - Y J Chang
- Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan, ROC.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - K Hall
- Department of Communication Sciences and Disorders, College of Health and Sciences, North Carolina Central University, NC, USA
| | - S H Lee
- School of Nursing, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - H T Chiu
- Neonatal Intensive Care Unit, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - S F Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - K L Sheu
- Department of Family and Community Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - S C Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.,Department of Family and Community Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
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13
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Malak R, Sikorska D, Rosołek M, Baum E, Mojs E, Daroszewski P, Matecka M, Fechner B, Samborski W. Impact of umbilical cord arterial pH, gestational age, and birth weight on neurodevelopmental outcomes for preterm neonates. PeerJ 2021; 9:e12043. [PMID: 34567841 PMCID: PMC8428260 DOI: 10.7717/peerj.12043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study was to determine the impact of umbilical cord arterial pH, gestational age, and birth weight on neurodevelopmental outcomes for preterm neonates. Methods We examined 112 neonates. Inclusion criteria were: Saturations greater than 88%, and heart rates between 100–205 beats per minute. Measurements We assessed several neurodevelopmental factors as part of the Brazelton Neonatal Behavioral Assessment Scale (NBAS), 4th edition, such as asymmetric tonic neck reflex (ATNR), motor maturity, response to sensory stimuli, habituation, and state regulation. Initial assessment parameters such as APGAR score and umbilical cord arterial pH were used to assess neonates. Results We found a strong correlation between the presence of the sucking reflex and umbilical cord arterial pH (r = 0.32; p = 0.018981). Umbilical cord arterial pH was also correlated with the presence of asymmetric tonic neck reflex (r = 0.27; p = 0.047124), cost of attention (r = 0.31; p = 0.025381) and general motor maturity (r = 0.34; p = 0.011741). Conclusions We found that the sucking reflex may be affected in infants with low umbilical cord arterial pH values. Practitioners and parents can use the NBAS to help determine neurodevelopmental factors and outcomes in preterm infants, possibly leading to safer and more effective feeding practices and interventions.
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Affiliation(s)
- Roksana Malak
- Department and Clinic of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Science, Poznań, Poland, Poznań, Wielkopolskie, Great Poland, Polska
| | - Dorota Sikorska
- Department and Clinic of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Science, Poznan, Polska
| | - Marta Rosołek
- Department of Physiotherapy, Poznan University of Medical Science, Poznań, Poland, Poznan University of Medical Science, Poznan, Polska
| | - Ewa Baum
- Department of Social Sciences and the Humanities Poznan University of Medical Sciences, Poznan, Polska
| | - Ewa Mojs
- Department of Clinical Psychology, Poznan University of Medical Sciences, Poznań, Poland, Poznan University of Medical Science, Poznan, Polska
| | - Przemysław Daroszewski
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Poznan, Polska
| | - Monika Matecka
- Department of Geriatrics and Gerontology, Poznan University of Medical Sciences, Poznan, Polska
| | - Brittany Fechner
- Department and Clinic of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Science, Poznan, Polska
| | - Włodzimierz Samborski
- Department and Clinic of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Science, Poznan, Polska
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14
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Li L, Wang L, Niu C, Liu C, Lv T, Ji F, Yu L, Yan W, Dou YL, Wang Y, Cao Y, Huang G, Hu X. Early skin contact combined with mother's breastfeeding to shorten the process of premature infants ≤ 30 weeks of gestation to achieve full oral feeding: the study protocol of a randomized controlled trial. Trials 2021; 22:637. [PMID: 34535164 PMCID: PMC8447630 DOI: 10.1186/s13063-021-05605-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Most hospitalized preterm infants experience difficulties in transitioning from tube feeding to full oral feeding. Interventions to promote full oral feeding in preterm infants in the neonatal intensive care unit (NICU) are limited to pacifier use or bottle-feeding exercises. Skin contact has been shown to be beneficial to start and maintain lactation and provide preterm infants with the opportunity to suck on the mother’s breast, which may promote further development of the preterm infant’s suckling patterns. The objective of this study is to compare and evaluate the effects of skin contact combined with breastfeeding (suck on the mother’s empty breast) as compared to the routine pacifier suckling training model in achieving full oral feeding for infants whose gestational age are ≤ 30 weeks. Methods This is a single-center, randomized controlled clinical trial conducted in the NICU and designed according to the SPIRIT Statement. The subjects included in the study are premature infants born between April 2020 and July 2021 with a gestational age of ≤30 weeks, birth weight of <1500 g, admission age of <72 h, and absence of congenital malformations. Those with oxygenation indices of >40 and those born to mothers with poor verbal communication skills will be excluded. A sample of 148 infants is needed. The infants will be randomized to the intervention (skin contact combined with mother’s breastfeeding model) or control group (routine pacifier sucking training model). The primary outcome is the time required to achieve full oral feeding. The secondary outcomes are the breastfeeding abilities of preterm infants as assessed by the Preterm Infant Breastfeeding Behavior Scale (PIBBS), breastfeeding rates at 3 and 6 months corrected gestational age, complication rates, duration of oxygen requirement, days of hospital stay, and satisfaction of parents. Discussion This paper describes the first single-center, open-label, randomized clinical trial on this topic and will provide crucial information to support the implementation of skin contact combined with the breastfeeding model in the NICU setting. Trial registration ClinicalTrials.gov NCT 04283682. Registered on 8 February 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05605-x.
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Affiliation(s)
- Liling Li
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Li Wang
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Conway Niu
- King Edward Memorial Hospital, Western Australia, Subiaco, Australia
| | - Chan Liu
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Tianchan Lv
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Futing Ji
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Ling Yu
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Weili Yan
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Ya Lan Dou
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yin Wang
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yun Cao
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Guoying Huang
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Xiaojing Hu
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
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15
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Lane A, Pacella J, Beal JR, Sahmoun AE, Fedo-Rosvold S, Bellas WM, Brower-Breitwieser C. A cross-sectional analysis of infant-driven and traditional feeding outcomes for neonatal intensive care unit infants. J Perinatol 2021; 41:1865-1872. [PMID: 34012051 DOI: 10.1038/s41372-021-01084-9] [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] [Received: 10/13/2020] [Revised: 03/31/2021] [Accepted: 04/29/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The goal of this study was to assess the impact of infant-driven feeding (IDF) compared to traditional feeding protocols in promoting earlier successful feeding outcomes. STUDY DESIGN We performed a cross-sectional analysis of infants admitted to a level three neonatal intensive care unit (NICU) over a 2-year period. We compared infants fed with the traditional protocol to those under the IDF protocol. RESULTS Infants in the IDF group were younger at first feed (p < 0.001). There was no difference in age at nasogastric (NG) tube removal or at discharge, length of stay, or percentage breastfeeding at discharge. There were no differences in outcomes within two subgroups born at <35 and <32 weeks gestation, respectively. CONCLUSION The IDF program led to earlier initiation of oral feeding. However, this did not lead to earlier NG tube removal or discharge, a shorter length of stay, or increase in the rates of breastfeeding.
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Affiliation(s)
- Audrey Lane
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Jonathan Pacella
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.
| | - James R Beal
- Department of Family Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Abe E Sahmoun
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Susan Fedo-Rosvold
- Neonatal Intensive Care Unit, Sanford Children's Hospital Fargo, Fargo, ND, USA
| | - William M Bellas
- Neonatal Intensive Care Unit, Sanford Children's Hospital Fargo, Fargo, ND, USA
| | - Carrie Brower-Breitwieser
- Sanford Health Eating Disorders and Weight Management Center, Fargo, ND, USA. .,Department of Psychiatry and Behavioral Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.
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16
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Chang YJ, Hao G, Huang JY, Yang SF, Huang CC, Chen SC. Clinical Validation of the Preterm Oral Feeding Readiness Assessment Scale in Taiwan. J Pediatr Nurs 2021; 59:e84-e92. [PMID: 33648837 DOI: 10.1016/j.pedn.2021.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE A successful transition from gavage to full oral feeding is a decisive indicator for discharging premature infants from the neonatal intensive care unit. A clinically useful measure of oral feeding readiness would help nurses initiate implementation of the cue-based feeding model in Taiwan. The study aimed to assess the validity and reliability of the Traditional Chinese Preterm Oral Feeding Readiness Assessment Scale (TC-POFRAS). DESIGN AND METHODS 81 preterm infants were enrolled and assessed by TC-POFRAS regarding their oral feeding readiness. This study included two phases. Phase 1 conducted a cross language validation procedure and item-level content validity indices (I-CVIs) for content validity were estimated. In phase 2, Cronbach's alpha for internal consistency at each category and total scale levels were estimated. A receiver operating characteristic (ROC) curve was estimated to explore the scale's performance. The optimal cut-off value of TC-POFRAS was identified by the best Youden's Index [maximum (sensitivity + specificity - 1)]. RESULTS All of the I-CVIs were 1.00. The whole Cronbach's alpha for internal consistency was 0.804 (95% CI = 0.736-0.862), and Cronbach's alpha values were between 0.538 (95% = 0.332-0.689) and 0.687 (95%CI = 0.572-0.781) for categories. The area under ROC was 92.2%, and an optimal cut-off value of TC-POFRAS was 29 (sensitivity: 0.938, specificity: 0.941). CONCLUSIONS The TC-POFRAS has been verified to be an effective and accurate instrument to determine the initiation of oral feeding in preterm infants. PRACTICE IMPLICATIONS The TC-POFRAS is an appropriate and complementary assessment instrument for professionals to conveniently use in clinical practice.
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Affiliation(s)
- Yu-Jung Chang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan; Speech and Language Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Grace Hao
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham NC, USA.
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Center for health data science, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Chia-Chen Huang
- Department of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Shiuan-Chih Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
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17
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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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18
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Osman A, Ibrahim M, Saunders J, Merheb R, Moscorelli M, Caretto V, Groh-Wargo S. Effects of Implementation of Infant-Driven Oral Feeding Guideline on Preterm Infants' Abilities to Achieve Oral Feeding Milestones, in a Tertiary Neonatal Intensive Care Unit. Nutr Clin Pract 2021; 36:1262-1269. [PMID: 33651895 DOI: 10.1002/ncp.10635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE This study examines the hypothesis that infant-driven oral feeding leads to earlier achievement of oral feeding and reduces the length of hospital stay compared with provider-driven oral feeding in premature infants METHODS: We used a retrospective chart review to compare 2 groups of premature infants born at ≤35 weeks of gestation. The control group (CG) received the Provider-Driven Oral Feeding model and the intervention group (IG) received the Infant-Driven Oral Feeding model. Postmenstrual age (PMA) upon achieving full oral feeding, PMA at first oral feeding, discharge weight, and length of hospital stay were compared between the groups. RESULTS There are 208 infants in CG and 170 infants in IG. Infants in IG were born, on average, at a lower gestational age and birth weight than infants in CG. The median PMA at full oral feeding of 35 2/7 weeks (interquartile range [IQR], 34 2/7-36 2/7) for IG is significantly lower than the median of 35 5/7 weeks (IQR, 35-36 5/7) for CG, P-value < 0.001. Median PMA at first oral feeding is 34 1/7 weeks for both groups. Median PMA at discharge was 36 6/7 weeks for both groups. Median discharge weights of 2509 g (IQR, 2175-2964) for IG and 2459 g (IQR, 2204-2762) for CG are not statistically different. CONCLUSION Implementation of the Infant-Driven Feeding guideline led to earlier achievement of full oral feeding by 3 days on average while maintaining the same discharge weight but did not lead to earlier hospital discharge.
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Affiliation(s)
- Ahmed Osman
- Division of Neonatology, Department of Pediatrics, Case Western Reserve University and MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Mujahid Ibrahim
- Division of Neonatology, Department of Pediatrics, Case Western Reserve University and MetroHealth Medical Center, Cork, Ireland
| | - Jean Saunders
- Centre for Support Training Analysis Research (CSTAR) and CSCS, University of Limerick, Limerick, Ireland
| | - Roula Merheb
- Division of Neonatology, Department of Pediatrics, Case Western Reserve University and MetroHealth Medical Center, Cleveland, Ohio, USA.,Division of Neonatology, Department of Pediatrics, Case Western Reserve University and MetroHealth Medical Center, Cleveland, OH, USA
| | | | | | - Sharon Groh-Wargo
- Division of Neonatology, Department of Pediatrics, Case Western Reserve University and MetroHealth Medical Center, Cleveland, Ohio, USA
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19
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Bakker L, Jackson B, Miles A. Oral-feeding guidelines for preterm neonates in the NICU: a scoping review. J Perinatol 2021; 41:140-149. [PMID: 33288867 DOI: 10.1038/s41372-020-00887-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This scoping review describes the nature and evidence base of internationally available guidelines for the introduction of oral feeding for preterm infants in neonatal units. STUDY DESIGN Thirty-nine current infant oral feeding introduction guidelines were obtained, and their recommendations contrasted with available scientific literature. RESULT Documents were primarily from the USA, UK, Canada, and Australia, from hospitals, regional health authorities, and journal articles. Specifics of nonnutritive sucking, gestational age at first feed, exclusions to oral feeding, suggested interventions, and the definition of full oral feeding varied between documents. There was variable use of scientific evidence to back up recommendations. CONCLUSION Guidelines for oral feeding, whether written by clinicians or researchers, vary greatly in their recommendations and details of interventions. Areas more widely researched were more commonly discussed. Recommendations varied more when evidence was not available or weak. Guideline developers need to synthesize evidence and local variability to create appropriate guidelines.
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Affiliation(s)
- Lise Bakker
- The University of Auckland, Auckland, New Zealand.
| | | | - Anna Miles
- The University of Auckland, Auckland, New Zealand
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20
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Singh H, Kusuda S, McAdams RM, Gupta S, Kalra J, Kaur R, Das R, Anand S, Pandey AK, Cho SJ, Saluja S, Boutilier JJ, Saria S, Palma J, Kaur A, Yadav G, Sun Y. Machine Learning-Based Automatic Classification of Video Recorded Neonatal Manipulations and Associated Physiological Parameters: A Feasibility Study. CHILDREN-BASEL 2020; 8:children8010001. [PMID: 33375101 PMCID: PMC7822162 DOI: 10.3390/children8010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022]
Abstract
Our objective in this study was to determine if machine learning (ML) can automatically recognize neonatal manipulations, along with associated changes in physiological parameters. A retrospective observational study was carried out in two Neonatal Intensive Care Units (NICUs) between December 2019 to April 2020. Both the video and physiological data (heart rate (HR) and oxygen saturation (SpO2)) were captured during NICU hospitalization. The proposed classification of neonatal manipulations was achieved by a deep learning system consisting of an Inception-v3 convolutional neural network (CNN), followed by transfer learning layers of Long Short-Term Memory (LSTM). Physiological signals prior to manipulations (baseline) were compared to during and after manipulations. The validation of the system was done using the leave-one-out strategy with input of 8 s of video exhibiting manipulation activity. Ten neonates were video recorded during an average length of stay of 24.5 days. Each neonate had an average of 528 manipulations during their NICU hospitalization, with the average duration of performing these manipulations varying from 28.9 s for patting, 45.5 s for a diaper change, and 108.9 s for tube feeding. The accuracy of the system was 95% for training and 85% for the validation dataset. In neonates <32 weeks’ gestation, diaper changes were associated with significant changes in HR and SpO2, and, for neonates ≥32 weeks’ gestation, patting and tube feeding were associated with significant changes in HR. The presented system can classify and document the manipulations with high accuracy. Moreover, the study suggests that manipulations impact physiological parameters.
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Affiliation(s)
- Harpreet Singh
- Child Health Imprints (CHIL) Pte. Ltd., Singapore 048545, Singapore; (S.G.); (J.K.); (R.K.); (R.D.)
- Correspondence: ; Tel.: +65-91-9910861112
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Tokyo 181-8612, Japan;
| | - Ryan M. McAdams
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA;
| | - Shubham Gupta
- Child Health Imprints (CHIL) Pte. Ltd., Singapore 048545, Singapore; (S.G.); (J.K.); (R.K.); (R.D.)
| | - Jayant Kalra
- Child Health Imprints (CHIL) Pte. Ltd., Singapore 048545, Singapore; (S.G.); (J.K.); (R.K.); (R.D.)
| | - Ravneet Kaur
- Child Health Imprints (CHIL) Pte. Ltd., Singapore 048545, Singapore; (S.G.); (J.K.); (R.K.); (R.D.)
| | - Ritu Das
- Child Health Imprints (CHIL) Pte. Ltd., Singapore 048545, Singapore; (S.G.); (J.K.); (R.K.); (R.D.)
| | - Saket Anand
- Department of Computer Science and Engineering, Indraprastha Institute of Information Technology, New Delhi 110020, India;
| | - Ashish Kumar Pandey
- Department of Mathematics, Indraprastha Institute of Information Technology, New Delhi 110020, India;
| | - Su Jin Cho
- College of Medicine, Ewha Womans University Seoul, Seoul 03760, Korea;
| | - Satish Saluja
- Department of Neonatology, Sir Ganga Ram Hospital, New Delhi 110060, India;
| | - Justin J. Boutilier
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin, Madison, WI 53706, USA;
| | - Suchi Saria
- Machine Learning and Healthcare Lab, Johns Hopkins University, 3400 N. Charles St, Baltimore, MD 21218, USA;
| | - Jonathan Palma
- Department of Pediatrics, Stanford University, Stanford, CA 94305, USA;
| | - Avneet Kaur
- Department of Neonatology, Apollo Cradle Hospitals, New Delhi 110015, India;
| | - Gautam Yadav
- Department of Pediatrics, Kalawati Hospital, Rewari 123401, India;
| | - Yao Sun
- Division of Neonatology, University of California, San Francisco, CA 92521, USA;
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21
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Celen R, Tas Arslan F, Soylu H. Effect of SINC Feeding Protocol on Weight Gain, Transition to Oral Feeding, and the Length of Hospitalization in Preterm Infants: A Randomized Controlled Trial. JPEN J Parenter Enteral Nutr 2020; 45:567-577. [PMID: 33236355 DOI: 10.1002/jpen.2049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/17/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present study aims to test the effect of the Safe Individualized Nipple-Feeding Competence (SINC) protocol on the preterm infants' weight gain, transition to oral feeding, and duration of hospitalization. METHODS The procedure was designed as a single-blind, parallel-group randomized controlled trial. The trial was conducted in a neonatal intensive care unit (NICU) in Konya, Turkey. Data were collected from 80 preterm infants between February 2018 and March 2019. Infants (gestational weeks 28-33) were randomly assigned to the intervention (n = 39) and control groups (n = 41). The intervention group received the SINC feeding protocol, whereas the control group received the standard feeding. Data were collected using the Family Information Form, the Preterm Infant Follow-Up Form, and the SINC Protocol Evaluation Checklist. Infants were followed from hospitalization to discharge. The outcomes were weight gain, transition to oral feeding, and the length of hospitalization from birth to discharge. Pearson χ2 test, Fisher exact test, independent t-test, Mann-Whitney U test, and general linear model test were used in analyzing the data. RESULTS The main effects of groups on weight measurements were found to be statistically significant (P < .001). There were no significant differences in terms of the transition from gavage to full oral feeding and the length of hospitalization (P > .05). CONCLUSIONS SINC protocol positively influences weight gain in preterm infants. It is important to evaluate different evidence-based feeding methods both as they apply to the NICU stay and how they may affect long-term outcomes of preterm infant.
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Affiliation(s)
- Raziye Celen
- Department of Pediatric Nursing, Faculty of Nursing, Selçuk University, Konya, Turkey
| | - Fatma Tas Arslan
- Department of Pediatric Nursing, Faculty of Nursing, Selçuk University, Konya, Turkey
| | - Hanifi Soylu
- Department of Pediatrics, Faculty of Medicine, Selçuk University, Konya, Turkey
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Turkish Neonatal Nurses' Knowledge and Practices Regarding the Transition to Oral Feeding in Preterm Infants: A Descriptive, Cross-sectional Study. J Pediatr Nurs 2020; 53:e179-e185. [PMID: 32321668 DOI: 10.1016/j.pedn.2020.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE Neonatal nurses play an important role in preterm infants' safe and successful transition to oral feeding. Little is known about neonatal nurses' knowledge and practices regarding the transition to oral feeding in preterm infants. The aim of this study was to determine neonatal nurses' knowledge levels and clinical practices related to the process of transitioning preterm infants to oral feeding. DESIGN AND METHOD This descriptive cross-sectional study was conducted with 275 neonatal nurses working in the neonatal intensive care units of 9 different hospitals in Istanbul, Turkey. Data were collected using a participant demographic form and a questionnaire about the neonatal nurses' knowledge and practices regarding oral feeding. RESULTS The mean knowledge score of the nurses in this study was 64.7 out of 100 (SD = ±8.7; range = 40-87.5). Rates of correct responses were particularly low for items related to cue-based feeding, interventions to promote oral-motor development, non-nutritive sucking, and infant positioning for oral feeding. All of the NICU nurses participating in the study did not use the protocols developed for transitioning preterm infants to oral feeding. CONCLUSIONS Nurses need knowledge and practical training on evidence-based therapeutic interventions that promote oral feeding skills in preterm infants during the transition to oral feeding. The use of protocols developed for transitioning preterm infants to oral feeding is limited in NICUs. PRACTICE IMPLICATIONS In order to facilitate safe and successful feeding, nurses should improve their knowledge and practical skills regarding the transition to oral feeding and evidence-based therapeutic interventions for preterm infants.
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Revisiting the roots of attachment: A review of the biological and psychological effects of maternal skin-to-skin contact and carrying of full-term infants. Infant Behav Dev 2020; 60:101441. [PMID: 32603951 DOI: 10.1016/j.infbeh.2020.101441] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 12/18/2022]
Abstract
During the early period of hypothesis building and empirical testing of attachment theory, a major emphasis was placed on mother-infant physical contact. In spite of this, mother-infant contact has received scant attention amongst attachment and child development researchers in the past decades. Here, a brief theoretical framework for mother-infant contact is presented, drawing on animal studies as well as human studies of preterm infants and neonates. Salient mechanisms may include an extended sensitive period during early infancy, requiring specific somatosensory stimuli for bio-behavioral homeorhesis; oxytocinergic and epigenetic pathways; kinesthetic stimuli and face-to-face proximity allowing for increased social interaction. Studies of extended human mother-full-term infant physical contact have demonstrated positive effects in multiple domains. For infants, these include sleep organization, temperature and heart rate regulation, behavioral response, crying/colic, socio-emotional development, attachment quality, speech development opportunities and mother-child interactions. For mothers, studies demonstrate improved depressive symptomatology, physiological stress regulation, contingent responsivity, breastfeeding and mother-child interactions. Parent-infant attachment quality has gained prominence as a trauma-resilience factor as well as a predictor of adult physical health. The potential role of mother-infant contact as an attachment promoting intervention as well as future research subjects are discussed. Current evidence supports the original attachment research that early maternal touch provision may influence infant socio-emotional development and attachment quality, with positive implications for mother-child relationship functioning.
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LaTuga MS, Mittelstaedt G, Moon JY, Kim M, Murray-Keane L, Si W, Havranek T. Clinical characteristics of premature infants who orally feed on continuous positive airway pressure. Early Hum Dev 2019; 139:104833. [PMID: 31476544 DOI: 10.1016/j.earlhumdev.2019.104833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/05/2019] [Accepted: 08/12/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Between 32 and 34 weeks postconceptional age (PCA), premature infants typically achieve neuromuscular maturation to initiate the coordination of a nutritive suck triad. Many premature infants also require intubation, which has been associated with dysphagia in adults and infants. At our institution, despite these factors, some infants have been noted to tolerate oral feeds while on continuous positive airway pressure (CPAP). AIMS Compare the clinical characteristics and duration of intubation in infants that initiate oral feedings on CPAP to infants that did not begin oral feeding on CPAP. STUDY DESIGN Retrospective case control study. SUBJECTS Infants with gestational age < 32 weeks who required CPAP at 32 weeks PCA. OUTCOME MEASURES Oral feeding was defined as any oral feed ≥5 ml. Duration of intubation was defined as the number of intubated days prior to 32 weeks PCA. RESULTS Of the 243 infants on CPAP at 32 weeks PCA, 31% (n = 76) began oral feeding on CPAP. Infants who initiated oral feeding on CPAP were of younger gestational age at birth (median 26 versus 27 weeks, p < 0.001) and remained intubated for longer (median 10.5 versus 2 days, p < 0.001). CONCLUSIONS Infants who began oral feeding on CPAP had lower gestational age and longer duration of intubation than infants who started oral feeding off CPAP.
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Affiliation(s)
- Mariam Susan LaTuga
- Department of Pediatrics, Albert Einstein College of Medicine, United States of America.
| | - Gina Mittelstaedt
- Department of Pediatrics, Albert Einstein College of Medicine, United States of America
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, United States of America
| | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, United States of America
| | - Lindsay Murray-Keane
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, United States of America
| | - Wendy Si
- Department of Pediatrics, Albert Einstein College of Medicine, United States of America
| | - Thomas Havranek
- Department of Pediatrics, Albert Einstein College of Medicine, United States of America
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Küçük Alemdar D, İnal S. The Effect of Individualized Developmental Care Practices in Preterm Infants. Complement Med Res 2019; 27:97-104. [DOI: 10.1159/000504357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/25/2019] [Indexed: 11/19/2022]
Abstract
Background: Preterm infants are vulnerable humans requiring much care and attention. They may be exposed to irregular noise, light, and odor in the neonatal intensive care unit for a period of several weeks or months. This study was carried out to determine the effect of individualized developmental care on physiological parameters, growth, and transition to oral feeding in preterm infants. Methods: The study was a randomized controlled trial. The sample comprised premature infants meeting the inclusion criteria. They were randomly assigned to four groups: the maternal voice group, the breast milk odor (BMO) group, the incubator cover (IC) group, and the control group. Results: No statistically significant difference was found between the groups in terms of weight, height, and head circumference at time of discharge. Mean SO2 values were statistically higher in the IC group than the other groups; however, the heart rate and respiratory rate were not statistically different in a significant sense between the groups. The briefest duration of transition to total oral feeding was seen in the BMO group. Conclusion: Individualized developmental care practices based on the results of these interventions are likely to support the care of preterm infants. Breast milk odor may ease the transition to breastfeeding.
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Yi YG, Oh BM, Shin SH, Shin JY, Kim EK, Shin HI. Association of uncoordinated sucking pattern with developmental outcome in premature infants: a retrospective analysis. BMC Pediatr 2019; 19:440. [PMID: 31722705 PMCID: PMC6854670 DOI: 10.1186/s12887-019-1811-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/29/2019] [Indexed: 01/24/2023] Open
Abstract
Background Stress signals during sucking activity such as nasal flaring, head turning, and extraneous movements of the body have been attributed to incoordination of sucking, swallowing, and respiration (SSR) in premature infants. However, the association of uncoordinated sucking pattern with developmental outcomes has not yet been investigated. The aim of this study was to investigate whether uncoordinated sucking pattern during bottle-feeding in premature infants is associated with the developmental outcomes at 8–12 and 18–24 months of age (corrected for prematurity). Methods We retrospectively reviewed the medical records and video recordings for the Neonatal Oral-Motor Assessment Scale (NOMAS) of premature infants and divided them into two groups based on the presence or absence of incoordination. The Bayley-III cognition composite scores of the incoordination-positive and incoordination-negative group were compared at 8–12 and 18–24 months of age. Results Seventy premature infants exhibited a disorganized sucking pattern according to the NOMAS. The average Bayley-III cognition composite scores at 8–12 months of age were 92.5 ± 15.6 and 103.0 ± 11.3 for the incoordination-positive (n = 22) and incoordination-negative groups (n = 48), respectively (p = 0.002). The average Bayley-III cognition composite scores at 18–24 months were 90.0 ± 17.9 and 100.7 ± 11.5 for the incoordination-positive (n = 21) and incoordination-negative groups (n = 46), respectively (p = 0.005). A multiple linear regression analysis indicated that the presence of uncoordinated sucking pattern, grade 3 or 4 germinal matrix hemorrhage–intraventricular hemorrhage, and moderate to severe bronchopulmonary dysplasia were independently associated with cognitive development at 18–24 months of age. Conclusions Uncoordinated sucking pattern in premature infants was independently associated with a higher risk of abnormal developmental outcome in the cognitive domain of the Bayley-III at both 8–12 and 18–24 months. There may be a need for periodic follow-up and early intervention for developmental delay when incoordination of SSR that results in stress signals on the NOMAS is observed before 40 weeks postmenstrual age.
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Affiliation(s)
- You Gyoung Yi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seung Han Shin
- Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jin Yong Shin
- Division of Occupational Therapy, Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ee-Kyung Kim
- Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Viswanathan S, Jadcherla S. Transitioning from gavage to full oral feeds in premature infants: When should we discontinue the nasogastric tube? J Perinatol 2019; 39:1257-1262. [PMID: 31366911 DOI: 10.1038/s41372-019-0446-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/09/2019] [Accepted: 06/12/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The optimal timing for discontinuation of nasogastric (NG) tube in premature infants transitioning to oral feeding is not known. OBJECTIVE To determine whether early removal of NG-tube is appropriate in low-risk premature infants. METHODS Prospectively collected data of premature infants started on oral feeds at ≤34 weeks gestation were reviewed. Infants were categorized into 'early' or 'late' NG-removal groups based on the proportion of oral intake in the preceding 2-days, i.e., 60-79% or 80-100% of the total volume, respectively. RESULTS In total 50 infants in early group vs. 43 in late group. Both groups had similar oral intake and weight change in the subsequent 2-days post-NG removal. The days from NG-removal to target oral volume, and to hospital discharge trended shorter in early vs. late group. CONCLUSIONS Discontinuing NG-tube when the oral feeding competency reaches ~75% of prescribed feeding volume is safe and appropriate in low-risk premature infants.
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Affiliation(s)
- Sreekanth Viswanathan
- Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA. .,Neonatal and Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Sudarshan Jadcherla
- Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.,Neonatal and Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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Effects of early communication intervention on speech and communication skills of preterm infants in the neonatal intensive care unit (NICU): A systematic review. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jnn.2019.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bell N, Harding C. An investigation of the flow rates of disposable bottle teats used to feed preterm and medically fragile infants in neonatal units across the UK in comparison with flow rates of commercially available bottle teats. SPEECH LANGUAGE AND HEARING 2019. [DOI: 10.1080/2050571x.2019.1646463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nicoll Bell
- NHS Trust, Barking, Havering and Redbridge University Hospitals, Romford, UK
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - Celia Harding
- Division of LCS, City, University of London, London, UK
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Weber A, Harrison TM. Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes. Nurs Outlook 2019; 67:169-189. [PMID: 30611546 PMCID: PMC6450772 DOI: 10.1016/j.outlook.2018.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/27/2018] [Accepted: 11/16/2018] [Indexed: 02/08/2023]
Abstract
In 2011, the American Academy of Pediatrics (AAP) published a technical report on the lifelong effects of early toxic stress on human development, and included a new framework for promoting pediatric health: the Ecobiodevelopmental Framework for Early Childhood Policies and Programs. We believe that hospitalization is a specific form of toxic stress for the neonatal patient, and that toxic stress must be addressed by the nursing profession in order to substantially improve outcomes for the critically ill neonate. Approximately 4% of normal birthweight newborns and 85% of low birthweight newborns are hospitalized each year in the highly technological neonatal intensive care unit (NICU). Neonates are exposed to roughly 70 stressful procedures a day during hospitalization, which can permanently and negatively alter the infant's developing brain. Neurologic deficits can be partly attributed to the frequent, toxic, and cumulative exposure to stressors during NICU hospitalization. However, the AAP report does not provide specific action steps necessary to address toxic stress in the NICU and realize the new vision for pediatric health care outlined therein. Therefore, this paper applies the concepts and vision laid out in the AAP report to the care of the hospitalized neonate and provides action steps for true transformative change in neonatal intensive care. We review how the environment of the NICU is a significant source of toxic stress for hospitalized infants. We provide recommendations for caregiving practices that could significantly buffer the toxic stress experienced by hospitalized infants. We also identify areas of research inquiry that are needed to address gaps in nursing knowledge and to propel nursing science forward. Finally, we advocate for several public policies that are not fully addressed in the AAP technical report, but are vital to the health and development of all newborns.
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Affiliation(s)
- Ashley Weber
- University of Cincinnati College of Nursing, 310 Proctor Hall, 3110 Vine St, Cincinnati, OH 45221, USA
| | - Tondi M. Harrison
- The Ohio State University, Newton Hall, College of Nursing, 1585 Neil Avenue, Columbus OH, 43210 USA
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Abstract
BACKGROUND The term "oral feeding success" (OFS) is frequently used in clinical practice and research. However, OFS is inconsistently defined, which impacts the ability to adequately evaluate OFS, identify risk factors, and implement interventions in clinical practice and research. PURPOSE To develop the defining attributes, antecedents, and consequences for the concept of OFS in preterm infants during their initial hospitalization. METHODS PubMed, CINAHL, and PsycINFO databases were searched for English articles containing the key words "oral feeding success" and "preterm infants." The Walker and Avant method for concept analysis was employed. RESULTS Sixteen articles revealed the defining attributes, antecedents, and consequences. Defining attributes included (1) physiologic stability; (2) full oral feeding; and (3) combined criteria of feeding proficiency (≥30% of the prescribed volume during the first 5 minutes), feeding efficiency (≥1.5 mL/min over the entire feeding), and intake quantity (≥80% of the prescribed volume). IMPLICATIONS FOR PRACTICE The 3 defining attributes may be used in clinical practice to consistently evaluate OFS. The antecedents of OFS provide clinicians with a frame of reference to assess oral feeding readiness, identify risk factors, and implement effective interventions. The consequences of OFS allow clinicians to anticipate challenges when OFS is not achieved and create a care plan to support the infants. IMPLICATIONS FOR RESEARCH The empirical referents of OFS provide consistent and clear operational definitions of OFS for use in research. The antecedents and consequences may guide researchers to select specific measures or covariates to evaluate valid measures of OFS.
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Khan Z, Sitter C, Dunitz‐Scheer M, Posch K, Avian A, Bresesti I, Urlesberger B. Full oral feeding is possible before discharge even in extremely preterm infants. Acta Paediatr 2019; 108:239-244. [PMID: 29953661 PMCID: PMC6585780 DOI: 10.1111/apa.14478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/17/2018] [Accepted: 06/26/2018] [Indexed: 12/01/2022]
Abstract
AIM This study described the steps needed to achieve full oral feeding before discharge in a group of very and extremely preterm (EPT) infants. We analysed the effects of oral feeding skills on discharge timing and on weight gain during their neonatal intensive care unit (NICU) stay. METHODS A prospective cross-sectional observational study of 100 infants who were <32 weeks of gestation (GA) was conducted at the Division of Neonatology, Graz, Austria, from March 2014 to February 2015. Patients were stratified into two groups: those who were <28 weeks at birth and those who were 28 weeks and over. Velocity of oral feeding skills attainment and weight gain were analysed. RESULTS All infants successfully acquired oral feeding skills during hospitalisation. The median GA at which full oral feeding skills were reached was 37 + 1 weeks in EPT and 34 + 5 weeks in very preterm infants. More immature neonates showed worse feeding performances and lower weight increments during oral feeding steps. CONCLUSION Our study confirmed the role of GA in the development of oral feeding skills in the most premature babies. It also raises the question of whether expected daily weight gain should be targeted according to GA.
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Affiliation(s)
- Zahra Khan
- Division of NeonatologyMedical University of GrazGrazAustria
- Department of Food Science and Human NutritionUniversity of Veterinary and Animal SciencesLahorePakistan
| | - Cornelia Sitter
- Division of NeonatologyMedical University of GrazGrazAustria
| | | | - Katrin Posch
- Division of NeonatologyMedical University of GrazGrazAustria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and DocumentationMedical University of GrazGrazAustria
| | - Ilia Bresesti
- Division of NeonatologyMedical University of GrazGrazAustria
- Division of NeonatologyV. Buzzi Children's HospitalASST‐FBF‐SaccoMilanItaly
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Morag I, Hendel Y, Karol D, Geva R, Tzipi S. Transition From Nasogastric Tube to Oral Feeding: The Role of Parental Guided Responsive Feeding. Front Pediatr 2019; 7:190. [PMID: 31143759 PMCID: PMC6521795 DOI: 10.3389/fped.2019.00190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/24/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Strategies to transition preterm infants from tube to oral feeding vary greatly and the transition may take days to weeks. The study objective was to evaluate the effect of parental guided responsive feeding (PGRF) on this transition. Methods: We conducted a randomized controlled trial on infants born at <32 weeks gestation. The PGRF intervention was performed by parents, and included feeding intervals and volumes which were guided by the infants' behavioral cues of hunger and satiety. If a minimum volume was not taken orally, an intermediate volume was supplemented via nasogastric tube. The control group was traditionally fed (TF), with pre-planned volumes of intake and at given scheduled intervals. Results: The study comprised 67 infants (PGRF 32, TF 35). PGRF infants reached full oral feeding within less days (median 2 vs. 8 days, p = 0.001), at an earlier age (median 34.28 vs. 35.14 weeks, p < 0.001), returned to baseline weight gain at 35 weeks (1.77 ± 0.70 vs. 1.25 ± 0.63 g/kg/day, p = 0.002), were discharged earlier (36.34 ± 0.6 vs. 36.86 ± 0.9 weeks, p = 0.001), were more likely to be fed by their parents (p < 0.001), and experienced less apnea/bradycardia events at 34 weeks (median 3.5 vs. 9 per week p = 0.047) compared to the TF infants. The regression model demonstrated that independent variables predicted 43.7% of the variance of time to full oral feeding [F (9, 65) = 4.84 p < 0.001]. The only significant variable was feeding group (B = -6.43 p < 0.001); The PGRF infants were more likely to reach full oral feeding earlier. Conclusion: PGRF is safe, and associated with short-term advantages, higher parental engagement, and earlier discharge. Clinical Trial Registration: Identifier: SHEBA-12-9574-IM-CTIL; "Adjusted Individual Oral Feeding for Improving Short and Long Term Outcomes of Preterm Infants."
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Affiliation(s)
- Iris Morag
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Chaim Sheba Medical Center, The Edmond and Lily Safra Children Hospital, Ramat Gan, Israel
| | - Yedidya Hendel
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel.,The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Dalia Karol
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ronny Geva
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel.,The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Strauss Tzipi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Chaim Sheba Medical Center, The Edmond and Lily Safra Children Hospital, Ramat Gan, Israel
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Peterson JK. Supporting Optimal Neurodevelopmental Outcomes in Infants and Children With Congenital Heart Disease. Crit Care Nurse 2018; 38:68-74. [PMID: 29858197 PMCID: PMC6563801 DOI: 10.4037/ccn2018514] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Improved survival has led to increased recognition of developmental delays in infants and children with congenital heart disease. Risk factors for developmental delays in congenital heart disease survivors may not be modifiable; therefore, it is important that lifesaving, high-technology critical care interventions be combined with nursing interventions that are also developmentally supportive. Implementing developmental care in a pediatric cardiac intensive care unit requires change implementation strategies and widespread support from all levels of health care professionals. This manuscript reviews developmentally supportive interventions such as massage, developmentally supportive positioning, kangaroo care, cue-based feeding, effective pain/anxiety management, and procedural preparation and identifies strategies to implement developmentally supportive interventions in the care of infants and children with congenital heart disease. Improving developmental support for these infants and children at high risk for developmental delay may improve their outcomes and help promote family-centered care.
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Affiliation(s)
- Jennifer K Peterson
- Jennifer K. Peterson is a PhD candidate at University of California, Irvine, Sue & Bill Gross School of Nursing, as well as the Children's Heart Institute Clinical Program Director at Miller Children's and Women's Hospital in Long Beach, California.
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Mother⁻Infant Physical Contact Predicts Responsive Feeding among U.S. Breastfeeding Mothers. Nutrients 2018; 10:nu10091251. [PMID: 30200623 PMCID: PMC6163497 DOI: 10.3390/nu10091251] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/24/2018] [Accepted: 09/04/2018] [Indexed: 12/27/2022] Open
Abstract
Responsive feeding—initiating feeding in response to early hunger cues—supports the physiology of lactation and the development of infant feeding abilities, yet there is a dearth of research examining what predicts responsive feeding. In non-Western proximal care cultures, there is an association between responsive feeding and mother–infant physical contact, but this has not been investigated within Western populations. In two studies, we tested whether mother–infant physical contact predicted feeding in response to early hunger cues versus feeding on a schedule or after signs of distress among U.S. breastfeeding mothers. With an online questionnaire in Study 1 (n = 626), physical contact with infants (via co-sleeping and babywearing) predicted increased likelihood of self-reported responsive feeding. Mothers who reported responsive feeding were more likely to exclusively breastfeed for the first six months, breastfeed more frequently throughout the day, and had a longer planned breastfeeding duration than mothers who reported feeding on a schedule or after signs of infant distress. In Study 2 (n = 96), a three-day feeding log showed that mother–infant physical contact predicted feeding in response to early hunger cues but mother–infant proximity (without physical contact) did not. In sum, our results demonstrate that physical contact with infants may shape breastfeeding behavior among U.S. mothers, highlighting a connection between social interaction and infant nutrition that warrants further investigation.
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Griffith TT, Bell AF, White-Traut R, Medoff-Cooper B, Rankin K. Relationship Between Duration of Tube Feeding and Success of Oral Feeding in Preterm Infants. J Obstet Gynecol Neonatal Nurs 2018; 47:620-631. [DOI: 10.1016/j.jogn.2018.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 02/01/2023] Open
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Perrella SL, Hepworth AR, Gridneva Z, Simmer KN, Hartmann PE, Geddes DT. Gastric emptying of different meal volumes of identical composition in preterm infants: a time series analysis. Pediatr Res 2018; 83:778-783. [PMID: 29166375 DOI: 10.1038/pr.2017.292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/01/2017] [Indexed: 11/09/2022]
Abstract
BackgroundPreterm infants' meals typically progress to higher volumes over time. Knowledge of gastric emptying (GE) responses to differing meal volumes may inform enteral feeding management. We examined the effect of meal volume and composition on preterm GE.MethodsForty infants were studied at 33.3±1.4 (29.7-35.6) weeks postmenstrual age when fully enteral fed (target 150 ml/kg/day). Intraindividual comparisons of GE were made for paired meals of 100% and 75% prescribed volume and identical composition of mother's own milk (n=21) and pasteurized donor human milk (n=19). Serial stomach ultrasound images were used to calculate gastric residual volumes (GRVs) and remaining meal proportions (% meal).ResultsGE was faster in the early postprandial period and slowed over time (P<0.001). Reduced volume meals had slower GE rates and lower GRV (P<0.001). Serial postprandial % meal was similar between reduced and full volume meals (P=0.41). Higher milk casein concentration was associated with slower GE (P=0.04). Complete gastric emptying (GRV=0 ml) was more common in infants fed at 3 h intervals compared with those fed every 2 h (P=0.002).ConclusionEarly postprandial GE is more rapid for larger meal volumes. Stable preterm infants may tolerate feeding of a 3 h meal volume at shorter intervals.
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Affiliation(s)
- Sharon L Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Anna R Hepworth
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Karen N Simmer
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, The University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Peter E Hartmann
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, Western Australia, Australia
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Girgin BA, Gözen D, Karatekin G. Effects of two different feeding positions on physiological characteristics and feeding performance of preterm infants: A randomized controlled trial. J SPEC PEDIATR NURS 2018; 23:e12214. [PMID: 29504676 DOI: 10.1111/jspn.12214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/31/2018] [Accepted: 02/07/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this randomized controlled study was to determine the effect of semielevated side-lying (ESL) and semielevated supine (ESU) positions, which are used to bottle-feed preterm infants, on their physiological characteristics and feeding performance. DESIGN AND METHODS The sample consisted of preterm infants who were born in the 31st gestational week and below, and met the inclusion criteria. A randomization was provided in the sample group with a total of 80 infants including 38 infants in the ESL (experimental) group and 42 infants in the ESU (control) group. Both groups were compared in terms of their SpO2 values, heart rates, and feeding performances before, during, and after the feeding. The data were obtained by using a form for infant descriptive characteristics, feeding follow-up form, a Masimo Radical-7 pulse oximeter device, and a video camera. RESULTS It was determined that the infants in the ESL group had statistically significantly higher SpO2 values (ESL: 96.77 ± 2.51; ESU: 93.48 ± 5.63) and lower heart rates (ESL: 155.87 ± 11.18; ESU: 164.35 ± 6.00) during the feeding compared to the infants in the ESU group (p < .05). Besides, oxygen saturation levels of the infants in the ESU group decreased more (p < .01) and their heart rates increased more (p < .05) during the feeding than those obtained before the feeding compared to the infants in the ESL group. PRACTICE IMPLICATIONS The ESL position has a more positive effect on oxygen saturation and heart rate of infants and it is more effective in providing a physiological stabilization during the feeding, compared to the ESU position. According to these results, the ESL position can be recommended for preterm feeding.
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Affiliation(s)
- Burcu Aykanat Girgin
- Faculty of Health Sciences Pediatric Nursing Department, Çankırı Karatekin University, Çankırı, Turkey
| | - Duygu Gözen
- Florence Nightingale Faculty of Nursing, Pediatric Nursing Department, Istanbul University, Istanbul, Turkey
| | - Güner Karatekin
- Division of Neonatology, Department of Pediatrics, Zeynep Kamil Maternity and Children Diseases Training and Research Hospital, Istanbul, Turkey
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Abstract
PURPOSE The purpose of this study is to describe implementation of the Co-Regulated Feeding Intervention (CoReg), when provided by mothers and guided by intervention nurses trained in methods of guided participation (GP). Co-regulated feeding intervention aims to prevent stress during feeding and ease the challenge very preterm (VP) infants experience coordinating breathing and swallowing during the early months. Guided participation is a participatory learning method to guide the complex learning required for mothers. STUDY DESIGN AND METHODS Sixteen mothers of 17 VP infants participated. Each mother received a median of five intervention sessions during the infant's transition to oral feeding. Intervention field notes, audio recordings of the sessions, and video recordings of the nurse-guided feedings were reviewed, organized, and content analyzed to evaluate implementation. RESULTS The co-regulated feeding intervention was well received by mothers; enrollment, participation, and retention rates were high. Most mothers chose to spread out the intervention sessions across the transition period. Scheduling sessions was the greatest barrier. Mothers had competing demands and infant readiness to eat could not be predicted. The top five issues identified as needing attention by the mother or nurse included reading cues, coregulating breathing, providing motoric stability, regulating milk flow, and providing rest periods. Main GP strategies included joint attention with the mother to the dyad's feeding challenges, auditory assessment of breathing and swallowing, and reflection with planning for future feedings using video playback. CLINICAL IMPLICATIONS Nurse presence while mothers feed affords rich opportunities to guide coregulated, cue-based feeding. Co-regulated feeding intervention would be enhanced if mothers are guided by the bedside nurse.
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Lubbe W. Clinicians guide for cue-based transition to oral feeding in preterm infants: An easy-to-use clinical guide. J Eval Clin Pract 2018; 24:80-88. [PMID: 28251754 PMCID: PMC5901413 DOI: 10.1111/jep.12721] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES This article aims to provide evidence to guide multidisciplinary clinical practitioners towards successful initiation and long-term maintenance of oral feeding in preterm infants, directed by the individual infant maturity. METHOD A comprehensive review of primary research, explorative work, existing guidelines, and evidence-based opinions regarding the transition to oral feeding in preterm infants was studied to compile this document. RESULTS Current clinical hospital practices are described and challenged and the principles of cue-based feeding are explored. "Traditional" feeding regimes use criteria, such as the infant's weight, gestational age and being free of illness, and even caregiver intuition to initiate or delay oral feeding. However, these criteria could compromise the infant and increase anxiety levels and frustration for parents and caregivers. Cue-based feeding, opposed to volume-driven feeding, lead to improved feeding success, including increased weight gain, shorter hospital stay, fewer adverse events, without increasing staff workload while simultaneously improving parents' skills regarding infant feeding. Although research is available on cue-based feeding, an easy-to-use clinical guide for practitioners could not be found. A cue-based infant feeding regime, for clinical decision making on providing opportunities to support feeding success in preterm infants, is provided in this article as a framework for clinical reasoning. CONCLUSIONS Cue-based feeding of preterm infants requires care providers who are trained in and sensitive to infant cues, to ensure optimal feeding success. An easy-to-use clinical guideline is presented for implementation by multidisciplinary team members. This evidence-based guideline aims to improve feeding outcomes for the newborn infant and to facilitate the tasks of nurses and caregivers.
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Affiliation(s)
- Welma Lubbe
- School of Nursing Science, INSINQ, North-West University (Potchefstroom Campus), South Africa
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Yi YG, Oh BM, Shin SH, Shin JY, Kim EK, Shin HI. Stress Signals During Sucking Activity Are Associated With Longer Transition Time to Full Oral Feeding in Premature Infants. Front Pediatr 2018; 6:54. [PMID: 29594085 PMCID: PMC5857543 DOI: 10.3389/fped.2018.00054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/26/2018] [Indexed: 11/13/2022] Open
Abstract
Several treatments have been proposed to shorten the time to the attainment of full oral feeding (FOF) for premature infants, but there are only a few evaluation methods useful in estimating predictors of this period. We investigated whether specific items within the disorganized sucking patterns described by the Neonatal Oral-Motor Assessment Scale (NOMAS) could estimate the time to FOF in preterm infants with feeding difficulty. Preterm infants diagnosed with a disorganized sucking pattern in the NOMAS evaluation before 50 weeks of postmenstrual age were included. Video recordings of at least 2 min of oral feeding were further analyzed retrospectively by two assessors and the premature infants who exhibited disorganized sucking patterns (n = 109) were divided into three clusters (clusters 2-4). The observational items compatible with disorganization in the original NOMAS were divided into three groups: cluster 2 (disorganized: arrhythmical), cluster 3 (disorganized: arrhythmical + unable to sustain), and cluster 4 (disorganized: arrhythmical + incoordination ± unable to sustain) and further divided into incoordination-positive (cluster 4) and incoordination-negative groups (clusters 2 and 3). Premature infants in the incoordination-positive group (cluster 4, which means stress signals) showed a median transition time of 22 days (range: 4-121 days) which was longer than that in the incoordination-negative group (median 6 days; range: 1-25 days). Univariate linear regression analysis revealed that the presence of incoordination among disorganized sucking patterns (NOMAS cluster 4 vs. clusters 2 and 3), birth weight, total parenteral nutrition (TPN) duration, non-invasive positive pressure ventilation duration, the presence of moderate to severe bronchopulmonary dysplasia, pulmonary hypertension, sepsis, small for gestational age (SGA), and necrotizing enterocolitis are associated with the transition time to FOF. In a multivariate linear regression analysis, the variables revealed to be associated with the transition time were TPN duration, SGA, and the presence of stress signals (incoordination-positive group) among disorganized sucking patterns. When selecting premature infants to be treated with swallowing therapy, it is reasonable to pay more attention to the incoordination-positive group described in the NOMAS, that is, premature infants with stress signals to shorten the time to attain FOF.
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Affiliation(s)
- You Gyoung Yi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Han Shin
- Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Jin Yong Shin
- Department of Pediatric Occupational Therapy, Seoul National University Children's Hospital, Seoul, South Korea
| | - Ee-Kyung Kim
- Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Harding C, Cockerill H, Cane C, Law J. Using non-nutritive sucking to support feeding development for premature infants: A commentary on approaches and current practice. J Pediatr Rehabil Med 2018; 11:147-152. [PMID: 29125505 DOI: 10.3233/prm-170442] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Non-nutritive sucking is often used with premature infants by either using a pacifier or an expressed breast nipple to support the introduction and development of early oral feeding. The pattern of non-nutritive sucking is distinct in that it involves two sucks per second in contrast to nutritive sucking which is one suck per second. Although some literature has identified that non-nutritive sucking has some benefit for the premature infant's feeding development, it is not entirely clear why such an approach is helpful as neurologically, activation of non-nutritive and nutritive skills are different. A summary is presented of the main approaches that use non-nutritive sucking with reference to the literature. This paper also considers other factors and beneficial approaches to managing the introduction of infant feeding. These are: the infant's toleration of enteral feeds pre oral trials, overall development and gestational age when introducing oral experiences, developing swallowing skills before sucking, physiological stability, health status, as well as the development and interpretation of infant oral readiness signs and early communication.
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Affiliation(s)
- C Harding
- Division of Language and Communication Sciences, City, University of London, London, UK
| | - H Cockerill
- Evelina Children's Hospital, Guy's and St. Thomas's NHS Trust, London, UK
| | - C Cane
- Starlight Neonatal Unit, Barnet Hospital, Royal Free NHS Foundation Hospitals Trust, London, UK
| | - J Law
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle, UK
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Suberi M, Morag I, Strauss T, Geva R. Feeding Imprinting: The Extreme Test Case of Premature Infants Born With Very Low Birth Weight. Child Dev 2017; 89:1553-1566. [PMID: 28800162 DOI: 10.1111/cdev.12923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Feeding imprinting, considered a survival-enabling process, is not well understood. Infants born very preterm, who first feed passively, are an effective model for studying feeding imprinting. Retrospective analysis of neonatal intensive care unit (NICU) records of 255 infants (Mgestational age = 29.98 ± 1.64) enabled exploring the notion that direct breastfeeding (DBF) during NICU stay leads to consumption of more mother's milk and earlier NICU discharge. Results showed that DBF before the first bottle feeding is related to shorter transition into oral feeding, a younger age of full oral feeding accomplishment and earlier discharge. Furthermore, the number of DBF meals before first bottle feeding predicts more maternal milk consumption and improved NICU outcomes. Improved performance in response to initial exposure to DBF at the age of budding feeding abilities supports a feeding imprinting hypothesis.
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Abstract
Feeding disorders often present in children with complex medical histories as well as those with neurodevelopmental disabilities. If untreated, feeding problems will likely persist and may lead to additional developmental and medical complications. Treatment of pediatric feeding disorders should involve an interdisciplinary team, but the core intervention should include behavioral feeding techniques as they are the only empirically supported therapy for feeding disorders.
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Do orally-directed behaviors mediate the relationship between behavioral state and nutritive sucking in preterm infants? Early Hum Dev 2017; 109:26-31. [PMID: 28431255 PMCID: PMC5479324 DOI: 10.1016/j.earlhumdev.2017.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 11/22/2022]
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The Relationship Between Behavioral States and Oral Feeding Efficiency in Preterm Infants. Adv Neonatal Care 2017; 17:E12-E19. [PMID: 27649302 DOI: 10.1097/anc.0000000000000318] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between behavioral states (alert, sleep, drowsy, and crying) and oral feeding efficiency in preterm infants is not well understood. PURPOSE To determine the relationship between behavioral states and feeding efficiency in preterm infants. METHODS This correlational study was conducted as a secondary analysis from a randomized controlled trial. Medically stable preterm infants born between 29 and 34 weeks' gestational age participated. Baseline data from the randomized controlled trial (week 0), 1 minute prior to feeding, were used. Behavioral states were coded by 2 blinded coders. Oral feeding efficiency (mL/min) was calculated as the amount of intake over the first 10 minutes of feeding. RESULTS Data from 147 infants were included. The proportion of time spent in alert states (β = .76, F = 11.29, P ≤ .05), sleep states (β = -1.08, F = 25.26, P ≤ .05), and crying (β = 1.50, F = 12.51, P ≤ .05) uniquely predicted oral feeding efficiency. IMPLICATIONS FOR PRACTICE Comprehensive assessment of behavioral states and infant characteristics for oral feeding readiness is crucial. Alert states are optimal for oral feeding. Forced oral feeding when infants are sleeping should be avoided. Infants in crying or drowsy states prior to feeding should be closely evaluated. Sleeping or drowsy infants may benefit from interventions (eg, oral sensory stimulation, nonnutritive sucking, or multisensory intervention) to support transition to alert states prior to feeding. IMPLICATIONS FOR RESEARCH Future research should evaluate behavioral states prior to and during feeding and their relationship to oral feeding efficiency.
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Abstract
BACKGROUND Feeding preterm infants in response to their hunger and satiation cues (responsive, cue-based, or infant-led feeding) rather than at scheduled intervals might enhance infants' and parents' experience and satisfaction, help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge. OBJECTIVES To assess the effect of a policy of feeding preterm infants on a responsive basis versus feeding prescribed volumes at scheduled intervals on growth rates, levels of parent satisfaction, and time to hospital discharge. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 1), MEDLINE via PubMed (1966 to 17 February 2016), Embase (1980 to 17 February 2016), and CINAHL (1982 to 17 February 2016). We also searched clinical trials' databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs that compared a policy of feeding preterm infants on a responsive basis versus feeding at scheduled intervals. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. We analysed the treatment effects in the individual trials and reported the risk ratio and risk difference for dichotomous data and mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We used a fixed-effect model in meta-analyses and explored the potential causes of heterogeneity in sensitivity analyses. We assessed the quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS We found nine eligible RCTs including 593 infants in total. These trials compared responsive with scheduled interval regimens in preterm infants in the transition phase from intragastric tube to oral feeding. The trials were generally small and contained various methodological weaknesses including lack of blinding and incomplete assessment of all randomised participants. Meta-analyses, although limited by data quality and availability, suggest that responsive feeding results in slightly slower rates of weight gain (MD -1.36, 95% CI -2.44 to -0.29 g/kg/day), and provide some evidence that responsive feeding reduces the time taken for infants to transition from enteral tube to oral feeding (MD -5.53, 95% CI -6.80 to -4.25 days). GRADE assessments indicated low quality of evidence. The importance of this finding is uncertain as the trials did not find a strong or consistent effect on the duration of hospitalisation. None of the included trials reported any parent, caregiver, or staff views. AUTHORS' CONCLUSIONS Overall, the data do not provide strong or consistent evidence that responsive feeding affects important outcomes for preterm infants or their families. Some (low quality) evidence exists that preterm infants fed in response to feeding and satiation cues achieve full oral feeding earlier than infants fed prescribed volumes at scheduled intervals. This finding should be interpreted cautiously because of methodological weaknesses in the included trials. A large RCT would be needed to confirm this finding and to determine if responsive feeding of preterm infants affects other important outcomes.
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Affiliation(s)
| | - William McGuire
- Centre for Reviews and DisseminationThe University of YorkYorkY010 5DDUK
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Crowe L, Chang A, Wallace K. Instruments for assessing readiness to commence suck feeds in preterm infants: effects on time to establish full oral feeding and duration of hospitalisation. Cochrane Database Syst Rev 2016; 2016:CD005586. [PMID: 27552522 PMCID: PMC6464358 DOI: 10.1002/14651858.cd005586.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND One of the most challenging milestones for preterm infants is the acquisition of safe and efficient feeding skills. The majority of healthy full term infants are born with skills to coordinate their suck, swallow and respiration. However, this is not the case for preterm infants who develop these skills gradually as they transition from tube feeding to suck feeds. For preterm infants the ability to engage in oral feeding behaviour is dependent on many factors. The complexity of factors influencing feeding readiness has led some researchers to investigate the use of an individualised assessment of an infant's abilities. A limited number of instruments that aim to indicate an individual infant's readiness to commence either breast or bottle feeding have been developed. OBJECTIVES To determine the effects of using a feeding readiness instrument when compared to no instrument or another instrument on the outcomes of time to establish full oral feeding and duration of hospitalisations. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 1), MEDLINE via PubMed (1966 to 22 February 2016), EMBASE (1980 to 22 February 2016), and CINAHL (1982 to 22 February 2016). We also searched clinical trials' databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised and quasi-randomised trials comparing a formal instrument to assess a preterm infant's readiness to commence suck feeds with either no instrument (usual practice) or another feeding readiness instrument. DATA COLLECTION AND ANALYSIS The standard methods of Cochrane Neonatal were used. Two authors independently screened potential studies for inclusion. No studies were found that met our inclusion criteria. MAIN RESULTS No studies met the inclusion criteria. AUTHORS' CONCLUSIONS There is currently no evidence to inform clinical practice, with no studies meeting the inclusion criteria for this review. Research is needed in this area to establish an evidence base for the clinical utility of implementing the use of an instrument to assess feeding readiness in the preterm infant population.
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Affiliation(s)
- Linda Crowe
- Mater Health ServicesNursing Research CentreBrisbaneAustralia
| | - Anne Chang
- Queensland University of TechnologySchool of NursingBrisbaneQueenslandAustralia
| | - Karen Wallace
- Mater Health ServicesMater Mothers HospitalLevel 1 Augbiny PlaceRaymond TerraceBrisbaneQueenslandAustralia
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Rustam LB, Masri S, Atallah N, Tamim H, Charafeddine L. Sensorimotor therapy and time to full oral feeding in <33weeks infants. Early Hum Dev 2016; 99:1-5. [PMID: 27372635 DOI: 10.1016/j.earlhumdev.2016.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous research has shown that oral stimulation improves feeding skills in preterm infants. However, it remains unclear whether other sensorimotor therapies have similar effect. OBJECTIVE To investigate the effect of sensorimotor therapy on the time to reach full oral feeding (FOF) in infants <33weeks. METHODS Retrospective review compared two time periods between 2009 and 2014, before (PRE TX) and after (POST TX) initiation of sensorimotor therapy to infants <33weeks. Type and number of sensorimotor therapy, time to FOF and length of stay (LOS) were collected. Statistical analysis used SPSS 22 for descriptive, non-parametric testing, chi-square and multivariate linear regression computation. RESULTS Of 245 records, 137 were excluded due to death, record unavailability/incompleteness or transfer. The remaining 55 in PRE TX and 53 in POST TX infants differed by small for gestational age (SGA) (36.4% vs. 28.3%, p=0.02); sepsis (81.8% vs. 54.7%, p=0.002); patent ductus arteriosus (PDA) (5.5% vs. 22.6%, p=0.01) and bradycardia (47.3% vs. 83%, p<0.0001). Infants in (POST TX) achieved FOF in 6.3±4.3days vs. 8.8±6.6days in (PRE TX) (p=0.02); their LOS was 56.8±26.4 vs. 52.2±25.1 (p=0.36). Predictors of days to FOF were any number of therapy sessions (β=-4.31; 95% CI: -6.47:-2.15), LOS (β=0.05; 95% CI: 0.004:0.09), PDA (β=3.23; 95% CI: 0.27:6.19) and bradycardia (β=2.94; 95% CI: 0.62:5.26). CONCLUSION Providing any type of sensorimotor therapy decreased time to reach FOF in infants <33weeks. Structured guidelines may help optimize this effect.
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Affiliation(s)
| | - Saadieh Masri
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Nathalie Atallah
- School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, Biostatistics Unit, American University of Beirut, Beirut, Lebanon
| | - Lama Charafeddine
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon.
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