Development Of Oral Feeding Skills Research Articles

The effect of oral motor intervention with different initiation times to improve feeding outcomes in preterm infants: protocol for a single-blind, randomized controlled trial

BackgroundPremature infants commonly encounter difficulties with oral feeding, a complication that extends hospital stays, affects infants’ quality of life, and imposes substantial burdens on families and society. Enhancing preterm infants’ oral feeding skills and facilitating their transition from parenteral or nasal feeding to full oral feeding pose challenges for neonatal intensive care unit (NICU) healthcare professionals. Research indicates that oral motor interventions (OMIs) can enhance preterm infants’ oral feeding capabilities and expedite the transition from feeding initiation to full oral feeding. Nonetheless, the most suitable timing for commencing these interventions remains uncertain.MethodsThis is a single-blind, randomized controlled trial. Preterm with a gestational age between 29+0 to 34+6 weeks will be eligible for the study. These infants will be randomized and allocated to one of two groups, both of which will receive the OMIs. The intervention commences once the infant begins milk intake during the early OMIs. Additionally, in the late OMIs group, the intervention will initiate 48 h after discontinuing nasal continuous positive airway pressure.DiscussionOMIs encompass non-nutritive sucking and artificial oral stimulation techniques. These techniques target the lips, jaw, muscles, or tongue of premature infants, aiming to facilitate the shift from tube feeding to oral feeding. The primary objective is to determine the ideal intervention timing that fosters the development of oral feeding skills and ensures a seamless transition from parenteral or nasal feeding to full oral feeding among preterm infants. Furthermore, this study might yield insights into the long-term effects of OMIs on the growth and neurodevelopmental outcomes of preterm infants. Such insights could bear substantial significance for the quality of survival among preterm infants and the societal burden imposed by preterm birth.Trial registrationchictr.org.cn ChiCTR2300076721. Registered on October 17, 2023.

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

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. 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. 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.). 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.

Clinical validation of the infant-driven feeding scales© in Turkey

BackgroundSupporting the development of feeding skills among preterm infants is an important component of neonatal care. The selection of appropriate and supportive feeding interventions begins with a comprehensive assessment of the infant's skills. PurposeThis study aimed to adapt the Infant-Driven Feeding Scales© (IDFS) to the Turkish language. MethodsThis was a methodological, observational, single-center cross-sectional study. The study included 80 infants born at a gestational age ≥ 32 weeks, consecutively admitted to a tertiary Neonatal Intensive Care Unit (NICU). Research data were collected using a premature infant descriptive information form (IDIF), IDFS, and LATCH Score for Breastfeeding Assessment. For the Turkish validity-reliability of the IDF, the translate-back translate method was used with the content validity index (CVI) assessed. ResultsThe scale had CVI values between 0.90 and 1.00 with a mean CVI = 0.96. For measures 1 and 2, there were significant positive and high-level correlations between IFDS-R and IFDS-Q correlation values (r = 0.553–0.958; p = 0.001) and significant negative, low-level correlations between IFDS-R and IFDS-Q with the LATCH scale (r = 0.439–0.532; p = 0.001). According to inter-observer compatibility analyses, the kappa value was 0.94–1.00 for the first measure and 0.96–1.00 for the second measure (p = 0.001). There were negative significant correlations between IDFS-R points with gestational age and postmenstrual age (PMA) (p = 0.001), and gestational age and PMA were explanatory factors for 13.8% of IDFS-R points (F = 7.30, p = 0.001). ConclusionsThe IDFS is recommended for use as a valid and reliable tool to ease the safe and successful development of oral feeding skills in preterm infants and to plan evidence-based interventions. Implications for practiceThe IDFS appears to be a beneficial measurement device for use in assessing the state of readiness of preterm infants for oral feeding and for early determination of risks that may occur due to delayed feeding independence of infants.

Assessing the Association Between Pre-operative Feeding and the Development of Oral Feeding Skills in Infants with Single Ventricle Heart Disease: An Analysis of the NPC-QIC Dataset.

Pre-operative feeding may improve long-term feeding outcomes in single ventricle patients, including weaning from supplemental tube feedings in infancy. This study examines the association between pre-operative enteral feeding and subsequent long-term feeding outcomes while also assessing the counterbalancing risk of necrotizing enterocolitis (NEC). Secondary analysis of the National Pediatric Cardiology Quality Improvement Collaborative database was performed. The association between pre-operative feeding practice and achieving all oral feeds through the first year of life was examined using a multivariable regression model. Similarly, the association between pre-operative oral feeding and NEC was also assessed. Of 944 patients with 1-year feeding outcomes available, 58% were fed preoperatively (41.3% exclusively oral) and 12.3% were not fed per institutional approach. At hospital discharge after Stage 1 palliation, 57% required a feeding tube, while 39% required a feeding tube at their first birthday. In infants who were orally fed, the odds ratio to achieving tube-free feeding at 1year was not significantly increased (1.3, confidence interval 0.8-2.0). Of 1740 infants with pre-operative feeding and Stage 1 there was no statistically significant difference in NEC among patients who were preoperatively fed versus those that were not fed per institutional approach (p = 0.2). Pre-operative feeding of infants with single ventricle heart disease was not associated with early achievement of tube-free feeding in the first year of life. However, pre-operative oral feeding was also not associated with increased risk of NEC, suggesting that it can be safely offered among appropriate patients.

The Development of Oral Feeding Skills in Infants

The Development of Oral Feeding Skills in Infants

Oral Feeding in the Preterm Infant

After completing this article, readers should be able to: 1. Describe the sequential development of sucking, swallowing, and respiration. 2. Delineate the limitation of an infant’s oral feeding skills at specific times of development to provide realistic expectations for oral feeding performance. 3. Define oral feeding success in preterm infants. 4. Use the current knowledge of preterm infants’ oral motor skills to facilitate and enhance their performance. 5. Enumerate the potential short- and long-term consequences of an infant’s oral feeding aversion for the patient, family, and health professional. Oral feeding issues in preterm infants are a growing concern for neonatologists because attainment of independent oral feeding is one of the prerequisites for hospital discharge. With the increase in survival of infants born continuously more preterm, understanding such issues has a certain urgency. Concerns do not pertain only to difficulties encountered by neonatologists during the birthstay hospitalization, but also by pediatricians and pediatric gastroenterologists who attend to long-term feeding difficulties/disorders, such as oral feeding aversion. Indeed, greater than 40% of patients followed in feeding disorder clinics are former preterm infants. Research over the last decade has begun to shed light on the development of oral feeding skills in these infants as they mature, which has increased understanding of their limited skills at varying postmenstrual ages. Such knowledge is crucial in clinical practice insofar as expectations of these infants’ oral feeding performance must take into account the ever-changing level of maturity of their skills. This article focuses on the development of sucking, swallowing, and respiration (as it pertains to oral feeding) and the coordination of these three functions. Additional factors, separate from infant feeding skills, also are discussed because they can affect oral feeding performance. This review examines information gathered from bottle feeding because more extensive research has been conducted on bottle feeding than on breastfeeding. However, …

Occurrence of oxygen desaturation events during preterm infant bottle feeding near discharge.

The purpose of this study was to examine the occurrence, severity, pattern, and moderators of oxygen desaturation during preterm infant bottle feeding near the time of discharge from the neonatal intensive care unit (NICU) when fed by mothers. Twenty-two very low birthweight (VLBW) infants [birthweight 1155+/-293 g, gestational age (GA) 28.1+/-2.0, postconceptional age (PCA) 36.5+/-1.6 weeks] were videotaped being bottle-fed by their mothers. Most infants (86%) were discharged within 6 days of the study. Oxygen saturation was continuously monitored and infant feeding behaviors were coded. Oxygen desaturation events (SpO(2)<90%) were identified and analyzed. Infants averaged 10.8 events during feeding (range 1-28, S.D. 8.9) and spent, on average, 20% of their feeding time (range 0-70%, S.D. 17.98%) with oxygen levels below 90%. One hundred forty of the desaturation events (59%) were classified as mild (SpO(2) 85-89), 47 events (20%) were classified as moderate (SpO(2) 81-84), and 51 events (21%) were classified as severe (SpO(2)</=80). Events were evenly distributed across infants' feeding time. Receiving supplemental oxygen, beginning the feeding with a higher baseline SpO(2), and being of older PCA predicted lower percentage of feeding time with SpO(2) below 90% (R(2)=0.57). Receiving supplemental oxygen and beginning the feeding with a higher baseline SpO(2) predicted less number of desaturation events during the feeding (R(2)=0.44). Despite similar baseline SpO(2) levels, infants who were on supplemental oxygen had 50% less oxygen desaturation events and spent 33% less time with SpO(2) less than 90%. VLBW infants continue to have desaturation events during feeding when fed by their mothers near the time of discharge. Further research is needed to understand the effect of hypoxemia on the preterm infant's development of oral feeding skills, to study the effects of supplemental oxygen during feeding, and to further develop interventions to minimize desaturation during feeding.