Risk Factors for Feeding and Swallowing Disorders in Very Low Birth Weight Infants in Their Second Year of Life

Identifying and evaluating factors related to feeding disorders in children using the path analysis method

Introduction

Pediatric feeding disorders (PFDs) refer to the impaired consumption of food that is inappropriate for a child's age group. Understanding the causes and influencing factors of PFDs is crucial for managing these disorders.

Aim

This study aimed to analyze the factors associated with PFDs using the path analysis method.

Material and methods

A cross-sectional study was conducted on 500 children aged 6 months to 18 years who visited gastroenterology and child nutrition clinics. Data were collected through interviews with mothers and physicians, and analyzed using the path analysis method. The model included latent variables such as feeding disorders and birth status, as well as observed variables such as socio-economic status, food group, feeding practices, destructive behaviors, sleep, and body mass index (BMI) z-score.

Results

We conducted three path analyses. The socio-economic status (SES) directly and indirectly plays a role in feeding disorders in children; the total effect on feeding disorders was positive (β = 0.075). The direct effect of SES on the intake of food groups was positive (β = 0.190), on BMI z-score was positive (β = 0.100), and it was generally associated with a negative effect on feeding disorders (β = -0.05). The total effect of destructive behaviors on body mass was negative (β = 0.262) and on feeding disorders was positive (β = -0.041). Children who had regular sleep had significantly fewer feeding disorders (total effect: -0.369).

Conclusions

Socio-economic status, destructive behaviors, sleep, and BMI were found to be factors influencing eating disorders in children.

Effect of sequential swallow training programme on feeding transition and suck-swallow-breath coordination in preterm infants

AIMS

To retrospectively evaluate the effect of a sequential swallow training programme (SSTP) consisting of nonnutritive sucking (NNS), modified feeding posture, oral sensory-motor intervention and breath exercise on the independent oral feeding transition and coordination of suck-swallow-breath (SSB) functions in preterm infants.

METHODS

Sixty preterm infants received SSTP intervention and sixty infants receiving NNS were set as control. The feeding performance and SSB coordination were assessed using POFRAS and NOMAS scales.

RESULTS

The transition interval were 8.42 ± 4.49 and 10.27 ± 5.05 days for SSTP and NNS group, respectively (P = 0.022). SSTP group had substantially more weight gains and shorter in-hospital stay than NNS. Two groups had comparable POFRAS and NOMAS scores before interventions, which were significantly increased after treatments in the two groups (P < 0.05). SSTP groups exhibited higher POFRAS scores, and better NOMAS performance reflected by the movement and coordination of jaw and tongue, especially in the normal sucking domain than the NNS group (P < 0.05). Both interventions significantly reduced the episodes of desaturation, apnea, and bradycardia, while no priority was shown for SSTP comparing with NNS. Multivariate linear regression analysis revealed that SSTP intervention was independently associated with decreased full oral feeding transition days, more weight gain during intervention and higher POFRAS score after intervention.

CONCLUSION

SSTP intervention shorten the transition days to full oral feeding and efficiently improved oral movement and coordination of SSB pattern when feeding.

Lung ultrasound supports clinical evaluation of feeding competence development in preterm neonates

Introduction

The achievement of alimentary competencies is a milestone in the development of preterm neonates. Ten percent of neonates <37 weeks of gestational age and 25% of those VLBW experience swallowing disorders, with an increased risk of problems in the early phase of life (failure to thrive, growth retardation, inhalation, and consequent risk of pulmonary infection) and later in life due to delayed development of oromotor skills.The main diagnostic tools for swallowing disorders are endoscopic (fiber-optic endoscopic examination of swallowing, FEES) or radiographic (videofluoroscopic swallowing study, VFSS) exams. Given the invasiveness of these methods and the bias due to rheologic differences between bolus and contrast medium, FEES and VFSS are poorly reproducible. Moreover, neither of the technique is capable of detecting post-meal inhalations, especially microinhalations or those consequent to a whole meal rather than to a single swallowing.Lung ultrasound (LUS) is a widespread, repeatable, safe, fast point-of-care tool and we reported previous encouraging results in detecting silent and overt inhalation related to the meal in children with dysphagia/gastroesophageal reflux disease (GERD) risk factors.

Methods

We report a pilot study, that investigated LUS approach (performing imaging before and after meals) to assess feeding competence development in a cohort of n. 19 newborns <32 weeks of age.

Results

Meal monitoring by LUS did not show any significant difference in scoring before/after eating. The achievement of full enteral feeding correlates with GA at birth (p < 0.001) but not with LUS scoring. The introduction of the first meal by bottle correlates both with gestational age (p < 0.001) and ultrasound scores (p = 0.004). LUS score at 7 days of life resulted predictive for length of invasive/non-invasive respiratory support (p = 0.002) and length of oxygen supply (p = 0.001), while LUS score at 48 h of life did not (p n.s.).

Discussion

Our study suggests that the development of oral feeding skills is not strictly dependent on gestational age. Moreover, our research suggests the predominant role of LUS in predicting the time of readiness to oral feeding, as the LUS score can be a marker of respiratory and lung wellness, and consequently a predictor of neonate stability during deglutitory apnea.