Bottle-Feeding Challenges in Preterm-Born Infants in the First 7 Months of Life

Factors associated with feeding problems in bottle-fed preterm infants: A descriptive cross-sectional study

BACKGROUND

The feeding problems of preterm infants often persist after neonatal intensive care unit discharge. Further evidence on the feeding problems preterm infants experience after hospital discharge is needed to better serve this vulnerable population. This study aimed to identify infant-related factors associated with bottle-feeding problems in preterm infants before the age of 7 months.

MATERIALS AND METHODS

This descriptive and cross-sectional study included 338 mothers of preterm infants younger than 7 months of corrected age between April 2023 and April 2024. Mothers completed a survey that included infant and mother information form and Turkish version of the NeoEAT-Bottle-feeding assessment tool.

RESULTS

Very and moderately preterm infants exhibited more problematic feeding symptoms according to NeoEAT-Bottle-feeding total scale and all subscale scores compared with late preterm infants (P < 0.05). Gestational age at birth was negatively correlated with NeoEAT-Bottle-feeding total scores (P = 0.001). Additionally, preterm infants with a diagnosed feeding problem had higher NeoEAT-Bottle-feeding total and subscale scores than those without (P < 0.01). In the multivariate regression analysis, very preterm status and presence of gastroesophageal reflux were predictors of higher NeoEAT-Bottle-feeding total and all subscale scores (P < 0.01), and moderately preterm status was associated with higher NeoEAT-Bottle-feeding total (P = 0.036) and infant regulation subscale scores (P = 0.001).

CONCLUSION

Very preterm and moderate preterm birth, gastroesophageal reflux, and diagnosed feeding disorders were associated with problematic feeding. Identifying preterm infants who have difficulty with bottle feeding can guide primary care interventions or referral to specialists to achieve more favorable long-term outcomes.

Prevalence of Parent-Reported Problematic Eating Behaviors and Skills at 8-24 Months of Age in Infants Born at Less Than 34 Weeks Gestation

PURPOSE

The purpose of this study was to describe the evolution and prevalence of parent-reported problematic feeding behaviors and eating skills in infants born prior to 34 weeks at the time of eating solid foods between 8 and 24 months of age, and to explore the associations between problematic feeding and the impact on the parent and family.

METHOD

Parents of eligible children (N = 35) completed an online survey when their child was 8, 10, 12, 18, and 24 months corrected age. The survey included the Pediatric Eating Assessment Tool (PediEAT), Child Oral and Motor Proficiency Scale (ChOMPS), and the Feeding Impact Scales-Family and Parent.

RESULTS

The prevalence of problematic feeding behaviors, as measured by the PediEAT, decreased from 63% at 8 months to 29% at 24 months. The prevalence of problematic eating skills, as measured by the ChOMPS, ranged from 30% to 56% between 8 and 24 months, with the highest prevalence between 10 and 18 months. The impact of feeding on the family and parent, as measured by the Feeding Impact Scales, was higher in families of children with problematic feeding than those without problematic feeding; however, given the small sample size, this was only statistically significant at 10 and 24 months.

CONCLUSIONS

The prevalence of problematic feeding in this population of infants under 34 weeks was 43%-44% over the first 2 years of life. Infants born preterm should be considered at elevated risk for problematic feeding and monitored closely with timely referrals. Identifying prevention strategies in the neonatal intensive care unit will be critical.

Prevalence and Predictors of Problematic Feeding at 1, 3, and 6 Months Corrected Age in Preterm Infants Born Prior to 34 Weeks

The purpose of this study is to describe the prevalence of problematic feeding in the first 6 months of life in infants born preterm, the impact of feeding problems on the family and parent, and explore which factors known at the time of neonatal discharge predict later symptoms of problematic feeding. The study design is a longitudinal, observational study. The sample included 43 infants born at 28.3 (23.57-33.86) weeks postmenstrual age at 1, 3, and 6 months corrected gestational age. The Infant Eating Assessment Tool and Feeding Impact Scales provided the main outcome variables. Prevalence of problematic feeding was 64% at 1 month, 66% at 3 months, and 29% at 6 months. Diagnosis of gastroesophageal reflux disease while in the NICU was the greatest predictor of problematic feeding in the first 6 months. Families and parents were more negatively impacted when their infant had problematic feeding.

Turkish adaptation of the Neonatal Eating Assessment Tool-Bottle-Feeding in preterm infants discharged to home

Background/aim

Preterm infants often continue to have feeding difficulties after hospital discharge. Parental use of assessment tools and collaboration with health professionals are important for the early diagnosis of postdischarge feeding difficulties. This methodological study examined the validity and reliability of the Turkish version of the Neonatal Eating Assessment Tool (NeoEAT)-Bottle-feeding in postdischarge preterm infants in Türkiye.

Materials and methods

A Turkish version of the NeoEAT-Bottle-feeding was developed and applied to 321 mothers of preterm infants younger than 7 months of corrected age between August 2021 and December 2022. Cronbach's alpha, exploratory factor, confirmatory factor, item-total correlation, test-retest, and known-groups validity analyses were performed.

Results

The Turkish NeoEAT-Bottle-feeding has 60 items in five factors explaining 55.785% of the total variance. Exploratory factor analysis indicated that the item factor loading ranged from 0.320 to 0.792. The known-group validity analysis confirmed that preterm infants with diagnosed feeding problems had higher total and subscale scores than those without (p = 0.001). The Cronbach's alpha (α) of the entire scale was 0.96. The item-total correlation coefficients were between 0.31 and 0.77 (p = 0.001). There was excellent agreement between test values and retest values obtained after a 2-week interval (intraclass correlation coefficient: 0.930-1.000).

Conclusion

The Turkish NeoEAT-Bottle-feeding was shown to be a reliable and valid parent-reported assessment tool for oral feeding skills and difficulties after neonatal intensive care unit discharge in bottle-fed preterm infants younger than 7 months of corrected age. Healthcare professionals can use this assessment tool during the initial evaluation of risk factors contributing to problematic feeding and to determine the effectiveness of planned interventions in preterm infants.

Bottle-Feeding Intervention Detection in the NICU

Video-based monitoring of patients in the neonatal intensive care unit (NICU) has great potential for improving patient care. Video-based detection of clinical events, such as bottle feeding, would represent a step towards semi-automated charting of clinical events. Recording such events contemporaneously would address the limitations associated with retrospective charting. Such a system could also support oral feeding assessment tools, as the patient's feeding skills and nutrition are pivotal in monitoring their growth. We therefore leverage transfer learning using a pretrained VGG-16 model to classify images obtained during an intervention, to determine if a bottle-feeding event is occurring. Additionally, we explore a data expansion technique by extracting similar-feature images from publicly available sources to supplement our dataset of real NICU patients to address data scarcity. This work also visualizes and quantifies the gap between the source domain (ImageNet data subset) and target domain (NICU dataset), thereby illustrating the impact of expanding our training set for knowledge transfer proficiency. Results show an increase of over 18% in sensitivity after data expansion. Analysis of network activation maps indicates that data expansion is able to reduce the distance between the source and target domains.

Milk Flow Rates From Bottle Nipples: What We Know and Why It Matters

Feeding difficulties are common in infants hospitalized in the NICU and can be a challenge to manage. The purpose of this article is to explain how and why the flow rate from the bottle nipple affects physiologic stability in infants and to describe the current evidence available on the flow rates of nipples used in the hospital and after discharge. Study results have indicated that flow rate varies widely among different types of nipples. Within the same type of nipple, there can be significant variability in flow from one nipple to another. Other factors, such as type of infant formula and thickening, also affect flow. Altering the flow rate of the bottle nipple is a relatively simple intervention that may support safe oral feeding.