Complete Oral Feeding Research Articles

Oral Feeding Challenges in Infants With Chronic Kidney Disease

Nutrition is a key component in the management of infants with chronic kidney disease (CKD). These infants often have poor appetites, small oral intakes, and difficulty meeting their nutritional requirements. The ability of dietitians, nurses, parents, and caregivers to ensure adequate nutritional intake can be complicated by a variety of oral feeding challenges. Without successful treatment, resulting malnutrition contributes to poor growth and potential for neurocognitive developmental delay. This article provides practical information for identifying and providing early intervention to alleviate common feeding challenges in infants with CKD. A collaborative, multidisciplinary approach focused on enhancing oral motor skills and encouraging positive eating experiences for infants helps to minimize stressful feeding experiences for parents. In addition, it supports successful transition from tube feeding to complete oral feeding following transplant.

Exploring Factors Related to Oral Feeding Progression in Premature Infants

To identify infant and maternal characteristics associated with the pace of progression from the first oral feeding to complete oral feeding. One hundred forty-two stable premature infants who were fully or partially gavage feeding immediately after birth (29 to 34 weeks gestational age at birth). Exploratory secondary analysis. Data are from an ongoing randomized clinical trial of a developmental maternally administered intervention (Hospital to Home Transition-Optimizing Premature Infant's Environment) for mother-infant dyads at high social-environmental risk. Oral feeding progression (transition time from the first attempt to complete oral feeding). The convenience sample of preterm infants consisted of 48.6% male infants; the mean gestational age at birth was 32.4 weeks and mean birth weight 1787 g; and African American mothers (47.9%; n = 80) and Latina mothers (52.1%; n = 83). Multivariable linear regression results showed that, on average, the number of days for infants of Latina mothers to achieve complete oral feeding was 2.43 days more than for infants of African American mothers. In addition, lower birth weight and lower postmenstrual age at first oral feeding were associated with longer feeding progression. Higher infant morbidity was correlated with longer feeding progression. Infants with Latina mothers, lower birth weight, lower postmenstrual age at first oral feeding, and higher morbidity scores had a longer transition from first to complete oral feeding. Identification of infants at risk for delayed transition from first to complete oral feeding may allow for the development and testing of appropriate interventions that support the transition from gavage to complete oral feeding.

Lack of Feeding Progression in a Preterm Infant

The purpose of this article was to present the case of a premature infant who displayed immature feeding progression because of nasal occlusion. Two male preterm infants of 33 weeks' gestational age at birth from a larger randomized trial were observed in a comparative case study. Using a prospective design, feeding assessments were conducted weekly from initiation of oral feeding until hospital discharge. Sucking organization was measured using the Medoff-Cooper Nutritive Sucking Apparatus (M-CNSA), which measured negative sucking pressure generated during oral feedings. Oral and nasogastric (NG) intake and vital signs were recorded. At 35 weeks, infant A demonstrated an immature feeding pattern with the M-CNSA NG feedings prevailing over oral feedings. When attempting to feed orally, infant A exhibited labored breathing and an erratic sucking pattern. During the third weekly feeding evaluation, nasal occlusion was discovered, the NG tube was discontinued, and phenylephrine (Neo-Synephrine) and humidified air were administered. Following treatment, infant A's sucking pattern normalized and the infant maintained complete oral feeding. Infant B demonstrated normal feeding progression. Nasal occlusion prevented infant A from achieving successful oral feeding. The M-CNSA has the ability to help clinicians detect inconsistencies in the sucking patterns of infants and objectively measures patterns of nutritive sucking. The M-CNSA has the potential to influence clinical decision making and identify the need for intervention.

Hypopharyngeal Pharyngoplasty in the Treatment of Severe Aspiration Following Skull Base Tumor Removal

To report the surgical treatment of severe swallowing disorders associated with skull base surgery resulting in unilateral pharyngolaryngeal paralysis in pediatric patients. Retrospective case review. Tertiary referral center for pediatric otolaryngology. Five infants undergoing swallowing rehabilitation surgery for severe dysphagia and aspiration resulting from skull base or brainstem surgery. A hypopharyngeal pharyngoplasty, consisting of the partial resection of the inferior constrictor and cricopharyngeal muscles, was performed for the treatment of severe swallowing disorders. A thyroplasty was also performed if clinically significant glottic incompetence was present. Functional outcomes after surgery were evaluated with a videoendoscopic swallowing study and videofluoroscopy. Postoperative clinical evaluation included respiratory, swallowing, and nutritional outcomes. A hypopharyngeal pharyngoplasty was performed following a mean period of 6 weeks (range, 1-10 weeks) after skull base surgery. In 3 patients a thyroplasty and a temporary tracheotomy were performed. Oral feeding was reintroduced after a mean period of 6 days (range, 4-20 days). Complete oral feeding autonomy was obtained after 13 days (range, 7-25 days). Postoperative swallowing assessment revealed the disappearance of pharyngeal stasis and aspiration in all patients. Three infants died because of tumor recurrence. Neither dysphagia or bronchopulmonary infections were observed after a mean follow-up period of 33 months (range, 6-61 months). Pharyngolaryngeal paralysis represents a severe consequence of skull base and brainstem surgery. This condition leads to high morbidity, particularly in the pediatric population. The hypopharyngeal pharyngoplasty, with a possible thyroplasty, may be considered to treat patients with severe pharyngolaryngeal paralysis after skull base or brainstem surgery.

Implementing Fast‐Track Protocol for Colorectal Surgery: A Prospective Randomized Clinical Trial

Fast-track protocols are followed by an enhanced recovery, early return to bowel function and to complete nutrition, and a reduced hospital stay. Our study was designed to implement fast-track protocol in our university hospital. The 96 consecutive patients with colorectal neoplasm included in the study were randomized in two equal groups: group 1 (FT) included patients undergoing colorectal surgery in a fast-track protocol, and group 2 (C) included patients undergoing colorectal surgery with a conventional care protocol. As with other fast-track protocols, our protocol included carbohydrate fluids load before operation, early mobilization and oral feeding, regular prokinetics, and multimodal postoperative analgesia. Time to restoration of bowel function, to complete mobilization and feeding, length of hospital stay, and incidence of complications and readmissions were monitored. Time to mobilization, restoring of bowel function, and complete oral feeding were significantly shorter with fast-track protocol (p = 0.001, p = 0.042, and p = 0.01, respectively). Hospital stay also was shorter in the fast-track group (p = 0.001). The incidence of complications did not significantly differ with the study groups. In our study, fast-track protocol resulted in a shorter time to mobilization, complete feeding, and discharge from hospital. Fast-track protocol did not increase the incidence of complications. However, we consider that our data require further confirmation with powered multicenter national studies.

Early “sham” feeding of neonates promotes oral feeding after delayed primary repair of major congenital esophageal anomalies

Background To promote the appropriate and early development of the suck and swallow mechanism, we instituted a “sham” feeding protocol in infants undergoing delayed primary repair of an esophageal atresia anomaly. Methods Four patients who were born with esophageal atresia required delayed repair and were sham fed before surgical correction. Each infant started with a small volume of oral feeds by using a bottle/nipple with a continuous Replogle suction system placed nasally into the esophageal pouch. They were carefully monitored. The volume of feeds was slowly increased as tolerated. Results All infants successfully completed the sham feeding protocol before undergoing delayed primary esophageal repair. After repair, they had a shortened time to full oral feeding. Conclusion Our “sham” feeding protocol is safe and very effective in early development of oral feeding mechanisms and shortens time to complete oral feeding after delayed esophageal repair.

Open vs. laparoscopic pyloromyotomy – a retrospective analysis

Laparoscopic pyloromyotomy has obtained increasing importance in the last years. However, there is no proof of an obvious advantage of the laparoscopic over the open approach. This retrospective analysis of 157 infants with pyloromyotomies (129 open and 28 laparoscopic procedures) should settle the benefit of one of these procedures. The duration of the operation in the laparoscopic procedure was significantly shorter than in open pyloromyotomy (median 25 versus 34 min; p = 0.025). Complete oral feeding was reached after similar postoperative time in both groups, but the postoperative hospital length of stay in the laparoscopic group was significantly shorter than in the open group (3.5 versus 7 days, p = 0.008). The postoperative requirements for analgetics were low and showed no difference in both groups. In our clinic the laparoscopic pyloromyotomy was successfully introduced as standard operating procedure. There was no difference in the complication rate as compared to the open procedure. The recovery time was shorter in the laparoscopic group. A superiority of the laparoscopic pyloromyotomy over the open procedure is suggested by the ascertained data.

Can levels of interleukins and matrix metalloproteinases in the amniotic fluid predict postnatal bowel function in fetuses with gastroschisis?

Purpose The aim of this study was to determine whether interleukin or matrix metalloproteinase (MMP) levels in the amniotic fluid can predict the postnatal condition of the bowel in fetuses with gastroschisis (GS). Methods Eleven pregnant women with a fetus with GS underwent amniocentesis. Levels of IL-1 α, IL-1 β, and IL-6 were measured in 10 of 11 specimens, and MMP-1, MMP-3, and MMP-8 levels were measured in 7 of 11 specimens. Neonates who tolerated complete oral feeding within 21 days were considered to have good bowel status (GS/good: n = 4, 4 in interleukin study or 3 in MMP study); those who did not were considered to have poor bowel status (GS/poor: n =7, 6 in interleukin study or 4 in MMP study). Seventy-eight women undergoing amniocentesis for other reasons served as controls. Results Interleukin-1 levels were considerably lower in the pregnancies complicated by GS than in controls. Matrix metalloproteinases 3 and 8 levels were significantly higher in the GS pregnancies than in controls. Neonates with poor bowel status had higher MMP-3 and MMP-8 levels than those with good bowel status. Conclusion Amniotic fluid MMP-3 and MMP-8 levels may prove useful to assess the condition of the bowel in fetuses with GS.

Isolated Small Bowel Transplantation from a Living-Related Donor at the Catholic University of Korea: A Case Report of Rejection - Free Course -

The bowel transplantation team at the Catholic Medical Center, Korea, on April 9 2004, accomplished a case of isolated small bowel transplantation (SBT) in a 57 year-old female with short bowel syndrome. The primary surgery was a jejunocolostomy due to mesenteric vein thrombosis, while maintaining 30 cm of the jejunum and colon distal to the splenic flexure. Her renal function was partially unbalanced. During more than 2 years of home TPN, the superior vena cava (VC) and subclavian veins had become occluded, but the inferior VC line remained. SBT was planned due to the repeated life-threatening infections of the last central line. One hundred and fifty centimeter of the distal ileum of the 27 year-old living-related donor, the patient's daughter, was harvested. The graft mesenteric artery and vein were anastomosed to the recipient's inferior mesenteric vessels. A proximal end-to-end jejuno-ileostomy and a distal end-to-side ileo-colostomy of the graft were made, creating a Bishop-Koop enterostomy for graft surveillance. A tube jejunostomy, via a gastrostomy, was established for early feeding and simultaneous gastric drainage. Induction with Daclizumab and immunosuppression consisted of tacrolimus and methylprednisolone, given intravenously, and then mycophenolate mofetil (MMF), enterally from day 3. The patient was discharged on day 42. A CMV infection on day 83 was successfully treated with 3 weeks of gancyclovir therapy. She has been nutritionally independent, with complete oral feeding, and free of rejection until day 170 after the transplantation.

Feeding tolerance in premature infants fed fortified human milk.

To evaluate feeding tolerance in premature infants immediately after the addition of human milk fortifier (HMF) to their expressed human milk diet. Data on milk intake, feeding tolerance, and related assessments and growth milestones from a prospective study of feeding strategies in premature infants were analyzed. The database was searched for the first day HMF was added to the feeding of infants receiving human milk exclusively. The following assessments were tabulated for the 5 days before and the 5 days after the addition of HMF: milk intake, the number of episodes of abdominal distension, gastric residual volume (GRV) more than 2 ml/kg and more than 50% of the volume fed in the prior 3 hours. bile-stained gastric residual, emesis or regurgitation, blood in the stool, the number of abdominal radiographs, the number of episodes of apnea and bradycardia, changes in findings in the clinical examination, and the number of hours feeding was withheld. The time to achieve full tube feeding, complete oral feeding, and hospital discharge were recorded. Seventy-six exclusively human milk-fed premature infants (birth weight, 1065+/-18 g; gestational age, 27+/-0.1 weeks; mean +/- SEM) who received HMF beginning 22+/-0.8 days of age were evaluated. There were significant increases in milk intake and in the number of episodes of GRV more than 2 ml/kg and emesis after the addition of HMF. There were no differences in the number of hours feeding was withheld or any other assessment after the addition of HMF. Infants with increases in GRV more than 2 ml/kg and/or emesis after the addition of HMF were not more likely to be delayed in the time to achieve full tube feeding, complete oral feeding, or hospital discharge than infants who did not experience these events. These data suggest that, when all feeding and related assessments and the time to achieve important growth milestones are considered, the addition of HMF does not adversely affect the outcome of the premature infant.

Effects of nutrients in human milk on the recipient premature infant.

As the rate of survival of premature infants is increasing, more attention is necessarily focused on improving the quality of survival through optimal nutritional management. The nutritional needs of the premature infant are greater than at any other time in the life cycle. The benefits of human milk for term infants are well known. Emerging data suggest that human milk may especially benefit the premature infant. The human milk-fed premature infant may experience improved health (such as lower rates of infection and necrotizing enterocolitis), gastrointestinal function, and neurodevelopment. These factors may outweigh the concerns about adequate growth, nutrient accretion, and biochemical indices of nutritional status attributed to the lower nutrient content of human milk compared with preterm formula. Some of the nutritional concerns may be met by the use of multinutrient supplements during the time infants receive tube-feeding, generally the time prior to attaining complete oral feeding in-hospital. The available data suggest that the quality of survival of premature infants can be improved, both in the short-term and long-term, through the feeding of human milk.

Factors Associated With the Transition to Oral Feeding in Infants Fed by Nasogastric Tubes

Following a review of 100 infants fed by nasogastric tubes, medical factors associated with the length of transition to complete oral feeding were identified through correlational and multiple regression analyses. Six of the 100 infants had an extremely lengthy transition or never progressed to oral feeding; the remaining 94 infants progressed to oral feeding within 2 to 58 days. The total number of medical complications correlated significantly and positively with the length of transition. Digestive, respiratory, and cardiac complications were all significant predictors of the length of transition to oral feeding. The results of this study may assist occupational therapists in earlier identification of and intervention for infants fed by nasogastric tubes who are at risk for later oral feeding problems and a longer transition from nasogastric tube to oral feeding.

Management of dysphagia in a patient with closed head injury

This case report describes the evaluation and treatment of a closed head injured (CHI) patient with dysphagia and cognitive and language deficits. On October 27, 1985, the patient, a 35-year-old man, sustained multiple intracranial hemorrhages in a pedestrian-motor vehicle accident. Over a 4-month hospitalization in a rehabilitation setting, he progressed from nasogastric tube feeding to complete oral feeding with an unrestricted diet. When admitted to our inpatient rehabilitation unit 2 months after injury, the patient demonstrated confused, agitated, inappropriate behaviors and had a tracheostomy. He showed minimal neurologic impairment of his lips, tongue, face, jaw, velopharynx (i.e., palatopharyngeal isthmus), larynx, and respiratory motor mechanism. Three videofluoroscopic dysphagia studies were performed. Initial findings included pharyngeal paresis and laryngeal penetration of liquids. Safe swallowing was possible only by using compensatory strategies, such as decreasing bolus size and swallowing twice after each mouthful. Persisting cognitive and language deficits complicated the dysphagia treatment program. Behavior modification techniques, a structured environment, supervision, and family education were utilized to address the cognitive and language deficits contributing to dysphagia. The interactions of cognitive, language, and swallowing impairments are discussed. General considerations in the management of dysphagia in patients with closed head injuries are also addressed.