Effect of Predictable Oral Feeding on Sucking and Breathing in Preterm Infants

1. Effect of Predictable Oral Feeding on Sucking and Breathing in Preterm Infants

2. Rita H. Pickler, PhD, RN, PNP-BC, FAAN Professor and Nurse Scientist, Cincinnati Children’s Hospital Medical Center Affiliate Clinical Professor, University of Cincinnati Affiliate Research Professor, Ohio State University Barbara A. Reyna, PhD, RN, NNP Nurse Practitioner, VCU Health System Al Best, PhD Associate Professor, Virginia Commonwealth University Paul Wetzel, PhD Associate Professor, Virginia Commonwealth University Pallavi Ramnarain, PhD Marty Lewis, BS, RN VCU Health System

3. Brief Background • Transition from gavage to oral feedings is a major challenge for preterm infants • Competence at oral feeding is a criterion for hospital discharge • Few evidence-based protocols to guide clinicians • Potentially short and long-term effects to trial-and-error approaches to oral feeding for preterm infants

4. Study Aims • The specific aim of the study was to test four approaches to oral feeding introduction and progression. • The aim of this analysis was to test the effect of the feeding approaches on sucking and breathing in preterm infants.

5. Methods • RCT • Infants randomly assigned by morbidity strata to 1 of 4 , 14 day feeding approaches • 2 groups started at 32 weeks PMA; 2 groups started at 34 weeks PMA • 1 group at each starting PMA was offered oral feedings at each opportunity; 1 group at each starting was offered gradually increasing oral feedings • Infants observed at oral feeding once a day for 14 days and then biweekly until discharge

6. Sample Characteristics • 99 participants • 53 males; mean BW 1390 grams (590 to 2465) • 77 Black; 5 Hispanic • Morbidity measured by NMI: NMI 1=24; NMI 2= 17; NMI 3=33; NMI 4=9; NMI 5=16 • Groups • 32 Slow: Allocated/received intervention 28/19; 15 male; 20 Black; NMI 1=6, 2=6, 3=6,4=3,5=3 • 32 Max: Allocated/received intervention 28/26; 16 male; 22 Black; NMI 1=6, 2=4, 3=10, 4=2,5=4 • 34 Slow: Allocated/received intervention 27/24; 17 male; 21 Black; NMI 1=8, 2=4, 3=8, 4=2, 5=4 • 34 Max: Allocated/received intervention 24/20; 10 male; 21 Black; NMI 1=6, 2=5, 3=7, 4=2, 5=2

7. Why sucking and breathing? • Crucial to fluid intake and thus feeding functioning • Ability at one can affect functioning at the other • Breathing most likely affected by swallowing • Swallowing most likely affected by sucking • Coordination could be the best reflection of skill

8. Sucking Characteristics and Changes * <0.05

9. Breathing Characteristics and Changes * <0.05

10. Coordination of Feeding Activities Distribution of Percent Overlap (mean = 12.6, SD = 12.27) Distribution of Proportion of Feeding Time Spent in Overlapping Feeding Activities (mean = 0.58, SD = 0.186)

11. Suck-Breath Coordination

12. Summary of Findings • Sucking and breathing events changed with maturity with a greater number of events and generally enhanced functioning • Coordination at the end of the protocol showed a trend town less over lap in the later starting group with maximum experience

13. Conclusions • The components of sucking and breathing during oral feedings in preterm infants changes with maturity • The relationship or coordination of the sucking to breathing also changes with maturity although the activities of each appear to be independent of each other • Allow infants to mature prior to initiating oral feedings may improve overall feeding performance.

14. Future Research • Research is needed to further investigate the relationships between sucking and breathing activities as well as their development over time • The effect of sucking and breathing coordination on feeding outcomes should be examined • Interventions that support the optimal development of sucking and breathing should be considered