Factors associated with postmenstrual age at full oral feeding in very preterm infants.

Grégoire Brun,Myriam Bickle Graz,Eric Giannoni,Céline J Fischer Fumeaux,Umberto Simeoni

doi:10.1371/journal.pone.0241769

Abstract

AimWe aimed to identify variables associated with gestational age at full oral feeding in a cohort of very preterm infants.MethodsIn this retrospective study, all infants born below 32 weeks of gestation and admitted to a level III neonatal unit in 2015 were included. We dichotomized our population of 122 infants through the median age at full oral feeding, and explored which variables were statistically different between the two groups. We then used linear regression analysis to study the association between variables known from the literature and variables we had identified and age at full oral feeding.ResultsThe median postnatal age at full oral feeding was 36 6/7weeks post menstrual age (Q1-Q3 35 6/7-392/7), and was associated with the duration of hospital of stay. In the univariable linear regression, the variables significantly associated with full oral feeding were gestational age, socioeconomic status, sepsis, patent ductus arteriosus, duration of supplementary oxygen, of non-invasive and invasive ventilation, and bronchopulmonary dysplasia. In the multivariable regression analysis, duration of non-invasive ventilation and oxygen therapy, bronchopulmonary dysplasia, and patent ductus arteriosus were associated with an older age at full oral feeding, with bronchopulmonary dysplasia the single most potent predictor.DiscussionLung disease severity is a major determinant of age at full oral feeding and thus length of stay in this population. Other factors associated with FOF include socioeconomic status and patent ductus arteriosus, There is a need for research addressing evidence-based bundles of care for these infants at risk of long-lasting feeding and neurodevelopmental impairments.

Highlights

Worldwide, 10% of children are born preterm [1] and are at risk of lifelong disabilities, including neurodevelopmental impairments
We dichotomized our population of 122 infants through the median age at full oral feeding, and explored which variables were statistically different between the two groups
In the univariable linear regression, the variables significantly associated with full oral feeding were gestational age, socioeconomic status, sepsis, patent ductus arteriosus, duration of supplementary oxygen, of non-invasive and invasive ventilation, and bronchopulmonary dysplasia

Summary

Introduction

10% of children are born preterm [1] and are at risk of lifelong disabilities, including neurodevelopmental impairments. Brain growth and maturation is of paramount importance during these last weeks of gestation, and depends crucially on adequate nutrition [2]. Very preterm neonates generally require parenteral nutrition, while enteral feeding is provided in increasing doses. Once full enteral feeding is achieved, the transition period from tube to full oral feeds (FOF) is a major determinant of the length of stay in the neonatal unit [3] and depends notably on the maturation and efficiency of the coordination of sucking-swallowing and breathing. Feeding difficulties may have a negative impact on nutrition in the neonatal period and thereafter, which may lead to stunted growth, altered neurodevelopment and lower academic achievement, and potentially adult onset metabolic disease [6]. Among the many complications of preterm birth, feeding and nutritional issues carry a heavy burden in terms of financial and social cost [7]

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