P0938 NATURAL HISTORY OF ORAL FEEDING BEHAVIOR IN INFANTS BORN AT LESS THAN 30 WEEKS GESTATION

Abstract

Introduction: Full oral feeding (FOF) is a prerequisite for hospital discharge of the preterm infant. However, infants born at <30 weeks (wks) gestational age (GA) may be at risk for dysfunctional swallow and GE reflux leading to persistent chronic lung disease, apnea with hypoxic episodes, or food refusal, all of which prolong hospitalization and increase parent anxiety. Objective: We hypothesized that infants born at <25 wks versus >25 wks GA, or those with oxygen (O2) requirements at 36 wks postmenstrual age (PMA) would be less likely to achieve FOF by 42 wks PMA. Methods: A 45-month retrospective review was performed of 101 infants born at or transported to Johns Hopkins Hospital and transferred to Mt. Washington Pediatric Hospital when stable. We determined the PMA that infants <30 wks GA reached FOF and the effect of other covariates on this outcome. Kaplan-Meier (K-M) graphs were constructed to estimate the probability of failure to reach FOF by 54 wks PMA with/without O2 requirements at 36 wks PMA. Results: Gastrostomy tubes (GT) were required for 11 infants, all born at 26 wks. Between 23–30 wks GA, the chance of achieving FOF increased by 25% for each additional wk of gestation. K-M graphs estimated the probability of achieving FOF by 54 wks PMA to be 0.6, 0.80, and 0.98 in infants born <25 wks, 25–28 wks, and >28 wks, respectively (P<0.05). Also, the chance of failing to achieve FOF was 68% greater for infants needing O2 at 36 wks PMA. Of infants born <25 wks, 30% did not achieve FOF by 43 wks PMA, with 23% requiring GT placement.Table 1: Percent of infants (95% confidence level) at each PMA that acheived FOFConclusion: The success of preterm infants achieving FOF by discharge is inversely related to GA. Approximately one-third of infants <25 wks do not achieve FOF by 43 wks PMA. Furthermore, O2 dependence at 36 wks PMA significantly increases the chance of FOF failure. Delayed or unsuccessful oral feeding in extremely premature infants significantly impacts length of stay, discharge planning and parent education.