Abstract
Preterm infants are known to have long-term healthcare needs. With advances in neonatal medical care, younger and more preterm infants are surviving, placing a subset of the general population at risk of long-term healthcare needs. Oral feeding problems in this population often play a substantial yet under-appreciated role. Oral feeding competency in preterm infants is deemed an essential requirement for hospital discharge. Despite achieving discharge readiness, feeding problems persist into childhood and can have a residual impact into adulthood. The early diagnosis and management of feeding problems are essential requisites to mitigate any potential long-term challenges in preterm-born adults. This review provides an overview of the physiology of swallowing and oral feeding skills, disruptions to oral feeding in preterm infants, the outcomes of preterm infants with feeding problems, and an algorithmic approach to the evaluation and management of neonatal feeding problems.
Highlights
Occurring in over 10% of live births in the world annually, prematurity is considered a significant global healthcare problem [1,2]
In an infant born preterm, the mature sucking–swallowing coordination is preceded by non-nutritive sucking (NNS) at around 28–33 weeks, which refers to repetitive sucking on a pacifier or a closed nipple without resulting in the delivery of a liquid bolus for swallowing [12,13]
The phrase “feeding problems” is often used to describe a diverse group of etiologies resulting in inadequate nutritional intake orally and could range from oral feeding difficulties, gastroesophageal reflux (GER), dysmotility, and even systemic illnesses, contributing to the lack of a uniform definition for feeding problems
Summary
Occurring in over 10% of live births in the world annually, prematurity is considered a significant global healthcare problem [1,2]. Barker et al hypothesized that malnutrition during gestation could alter fetal metabolic programming leading to early-onset heart disease as adults [6] Prenatal factors such as maternal malnutrition, disease, environmental exposures, maternal stress, and lifestyle can affect the developmental programming of the fetus by altering the maternal–fetal en-. Oral feeding readiness in preterm infants is a concern often towards the tail-end of hospitalization. This only comes into the spotlight after other major medical concerns have been resolved or are manageable. While the evidence for the adult outcomes of preterm infants is increasing, the long-term impact of the altered development of oral neuromotor skills and abnormal oral feeding remains unclear, primarily due to a paucity of studies on adults born preterm. (2) disruptions to oral feeding in preterm infants, (3) feeding problems in preterm infants beyond the NICU, and (4) an algorithmic approach to the evaluation and management of neonatal feeding problems
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